Calcification of the cardiovascular system is now well recognized to be a common feature of patients with chronic kidney disease. It is increasingly prevalent in patients with more severe uremia, particularly those receiving dialysis. Furthermore, it is progressive in terms of both severity and associated functional cardiovascular consequences. Although well recognized to be associated with a markedly increased mortality rate, the pathophysiological processes that result in these poor outcomes are less well understood. This article attempts to review calcification of the cardiovascular system as a whole entity and how the structural and functional changes may translate to the observed patterns of disease seen in these patients.