A retrospective cohort study from three dialysis centers in South China included 402 peritoneal dialysis (PD) patients, mean age 45.3 ± 13.8 years, of which 55.5% were male, conducted from January 1, 2021 to December 31, 2024. Patients who achieved target hemoglobin levels were assigned to a roxadustat dose reduction group. (gradual reduction of quantity at the same frequency) and frequency reduction groups (reduction of frequency without changing the quantity per dose). During a 12-month follow-up with assessments every 3 months, no difference in trend of change or mean hemoglobin levels was observed between groups. The group with a reduced frequency had a significantly higher rate of achieving hemoglobin target values: 64.1% vs. 40.4% in the 3rd month, 55.6% vs. 43.2% in the 6th month and 49.2% vs. 36.6% at month 12 (all p < 0.05). This group showed lower hemoglobin variability measured by residual standard deviation (Res-SD): 12.3 vs. 15.5 (p < 0.05). A frequency reduction strategy was associated with a lower risk of not reaching the target hemoglobin level (adjusted HR 0.64, 95% CI 0.50–0.82; p < 0.001).