Purpose: This study aims to evaluate the effectiveness and cost-effectiveness of recombinant human erythropoietin (rHuEPO) and Roxadustat in treating renal anemia, particularly in athletic patients undergoing regular hemodialysis. Methods: Between January 2020 and December 2021, 150 athletic patients on continuous ambulatory regular hemodialysis were enrolled. They were divided equally into rHuEPO and Roxadustat groups. We assessed hemoglobin (Hb), hematocrit (Hct), serum ferritin (SF), and transferrin (TRF) levels, along with adverse reactions, allergic responses, coagulation function, and liver and kidney function parameters (ALT, CCr) before and after treatment. The study also compared the cost-effectiveness of these treatments. Results: Basic demographic information (gender, duration of illness, weight, dialysis method, age) showed no significant difference between groups (P > 0.05). The Roxadustat group demonstrated a significantly higher total effective rate (92.00%) compared to the rHuEPO group (74.67%), with P < 0.05. Post[1]treatment, improvements in Hb, Hct, SF, TRF, and coagulation and liver and kidney function indices were observed in both groups, with Roxadustat showing superior outcomes (P < 0.05). Adverse reactions were lower in the Roxadustat group (9.33%) compared to the rHuEPO group (24.00%), P < 0.05. Roxadustat's Incremental Cost-Effectiveness Ratio (ICER) was 41,134.10 yuan, deemed tolerable against the backdrop of thrice the per capita GDP. Conclusion: Both Roxadustat and rHuEPO are effective in treating renal anemia in athletes. However, Roxadustat shows superior efficacy, safety, ease of oral administration, patient acceptance, and cost-effectiveness. It becomes the preferred choice for athletic patients with a willingness to pay exceeding 41,134.10 yuan, marking it as the most economically viable option.