Cardiovascular complications due to accelerated atherosclerosis and arterial stiffening are the principal cause of morbidity and mortality in patients with dialysis. Both are frequently associated with vascular calcification. Uremia-specific factors are considered to play an important role in promoting these aortic wall changes, and may be more important than classical atherogenic risk factors. Disorders of calcium and phosphorus metabolism and secondary hyperparathyroidism have been recognized as independent risk factors of bone disease, and also soft tissue calcification, including arterial calcification and atheroma. The best strategy to treat, or even prevent, this complication would consist of control of serum phosphate concentration.