Objective To observe the effect of hypoxic inducible factor prolyl hydroxylase inhibitors on coronary artery calcification in maintenance hemodialysis patients. Methods From June 2019 to December 2021, 265 patients with maintenance hemodialysis (MHD) in the blood purification center of the First Affiliated Hospital of Chengdu Medical College and the Second Affiliated Hospital of Chengdu Medical College were selected as the research objects. They were divided into the control group (230 cases) and the roxadustat group (35 cases) according to whether they used roxadustat capsule or not. The general data of MHD patients were collected. The chest CT plain scan was performed with spiral CT, and the coronary artery calcification score of all MHD patients was calculated according to Agatston's quantitative method of coronary artery calcification. The t-test and rank sum test were used for the sampling comparison between the losartal group and the control group. Using the 1:4 matching propensity score with caliper value (standard deviation of 25%), the differences in coronary artery calcification score, blood calcium, hemoglobin, ferritin, low-density lipoprotein and cholesterol levels between the two groups were further statistically analyzed in the pseudo population data obtained after matching. Results Compared with the control group, there was no statistical significance in coronary artery calcification score in roxadustat group (P＞0.05). Compared with control group, hemoglobin and ferritin in roxadustat group were increased (P＜0.05). Serum calcium in roxadustat group was significantly decreased compared with control group (P＜0.05). Compared with control group, low density lipoprotein and cholesterol in roxadustat group had no statistical significance (P＞0.05). Conclusion Based on the propensity score, the use of rosalrestat increases hemoglobin and ferritin content, reduces blood calcium levels and does not increase the risk of vascular calcification in maintenance hemodialysis patients, providing evidence for the cardiovascular safety of rosalrestat use in maintenance hemodialysis patients