Nonvalvular atrial fibrillation patients with stage 4 or 5 chronic kidney disease or undergoing hemodialysis were excluded from phase III randomized trials of nonvitamin K antagonist oral anticoagulants (NOACs). We sought to evaluate the effectiveness and safety of rivaroxaban versus warfarin in nonvalvular atrial fibrillation patients with stage 4 or 5 chronic kidney disease or undergoing hemodialysis in routine practice.