This study evaluates the comparative efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation and coexisting kidney disease. Using a multicenter propensity score-matched cohort analysis, the research aims to minimize confounding variables and provide balanced comparisons between treatment groups. The investigation focuses on key clinical outcomes, including prevention of thromboembolic events, particularly ischemic stroke and systemic embolism, as well as safety endpoints such as major bleeding, intracranial hemorrhage, and overall mortality. Special emphasis is placed on how varying degrees of renal impairment influence anticoagulant pharmacokinetics, therapeutic effectiveness, and adverse event risk. The study seeks to clarify whether DOACs offer superior or comparable clinical benefits to VKAs in patients with chronic kidney disease, potentially supporting optimized anticoagulation strategies and personalized treatment selection in this high-risk population.