Patients affected by chronic kidney disease (CKD) suffer by secondary hyperparathyroidism and hyperphosphatemia. The new KDIGO guidelines identify a new definition in CKD-MBD (Mineral Bone Disorder), in which vascular calcification plays a central role. In fact, CKD patients that present vascular calcification have highest risk of cardiovascular morbility and mortality. Recently, it has been elucidated that the control of phosphate is one of the major problems for the nephrology community. Furthermore, new markers, such as FGF-23, have been identified as inducers of vascular calcification and cardiovascular disease in CKD. Therefore, the use of calcium-free phosphate-binders may reduce the risk of cardiovascular disease by reducing both serum phosphate and FGF-23 levels.