Cardiovascular morbidity and mortality are very common in patients with chronic kidney disease, and vascular calcification may contribute in part. Vascular calcification requires osteoblastic trans-differentiation of vascular smooth muscle cell through an active and highly regulated process, which has a number of morphologically and functionally similar parts with bone formation. Until recently, studies on this area have been actively continued, but it is true that there is no definite direction on the understanding and treatment of the precise mechanism. Therefore, this review aims to discuss the recent mechanism of vascular calcification, its effect on cardiovascular disease, and the therapeutic effort through the modulation of mineral metabolism.