Atrial fibrillation (AF) and chronic kidney disease (CKD) commonly coexist in the same patient, and presence of AF does increase the relative risk of stroke in patients with CKD at least to the same extent as in those with normal renal function. Based on these considerations, stroke prevention with oral anticoagulation (OAC) appears essential in patients with AF and CKD. However, patients with CKD also have a higher risk of both intracranial and extracranial haemorrhage. A delicate balance is therefore needed to shift the overall risk-to-benefit ratio toward stroke prevention with minimal possible risk of harm from serious bleeding with OAC use. However, do we have sufficient evidence to suggest best practice in these settings? Unfortunately, there are no clinical trials to unambiguously answer this important question and insight from observational studies and meta-analyses are important.