Vascular calcification is the most important type of the ectopic calcinosis in dialysis patients. Hyperphosphatemia is an independent risk factor for the vascular calcification. A sodium-dependent phosphate co-transporter is associated with an increase in the intracellular phosphate concentration in vascular cells. After degeneration and/or apoptosis of smooth muscle cells in the vascular walls, macrophage infiltration into the calcified tissues followed by production of bone matrix protein leads to the vascular calcification. Uremic conditions such as hyperphosphatemia may enhance the vascular calcification. Therefore, we should treat the vascular calcification in association with bone remodeling in dialysis patients.