Chronic Kidney Disease (CKD) is closely related to hypertension. Increasing the severity
of CKD is associated with more difficult blood pressure control. Appropriate therapeutic management
is needed to prevent complications due to uncontrolled hypertension. We report the case of a 78-
year-old female patient with a diagnosis of hypertension and end-stage CKD with a history of
undergoing hemodialysis for 4 years. The patient has been taking antihypertensive drugs such as
Angiotensin Receptor Blockers, Calcium Channel Blockers and Diuretics. However, the
administration of three antihypertensive drugs still could not help achieve the expected blood
pressure target where the systolic blood pressure was still above 160 mmHg. The patient also has
anemia as a common complication of chronic kidney disease. Appropriate management of therapy
with fourth-line therapy and hemoglobin repair is necessary to achieve improved clinical outcomes
and reduce renal worsening