Background Erythropoiesis-stimulating agent (ESA) hyporesponsiveness is an important cause for the undertreatment of anemia. This study aimed to investigate the effectiveness and safety of adding HIF-PHI (roxadustat) to ESA for the treatment of ESA-hyporesponsive anemia in Peritoneal Dialysis (PD) patients. Methods This was a single-center prospective-designed study in PD patients of Huashan Hospital, Fudan University. Patients with ESA-hyporesponsive anemia were enrolled from January 2020 to April 2020 with a 24-week follow-up period. Patients were added with roxadustat at a starting dose of 50 or 100 mg thrice weekly without changing the ESA dose. Roxadustat and ESA dose adjustments were made as needed to maintain Hb levels within 11.0–13.0 g/dL. Efficacy outcomes and safety were assessed. Results A total of nine patients were recruited in the study. Both the cumulative responsive rate and the maintenance rate of patients with Hb>11g/dL were 100%. Six out of nine patients had ESA dose reduced from 15,000 UI/week or more to 7000 IU/week or less at week 24. No drug-related severe adverse event was reported in this study. Conclusion The present study showed that the addition of roxadustat not only effectively corrected anemia in patients who were resistant to ESA, but also reduced the dose of ESA.