Chronic renal failure results in disturbances of bone formation, degradation and mineralization and changes in bone volume. These bone changes as well as biochemical abnormalities of the blood have also been found to be associated with soft-tissue and blood vessel calcification. In fact, the patients suffer not only from skeletal problems but also from rapidly progressing arterial stiffening, which leads to early cardiovascular morbidity and mortality. Essential therapy consists of early management of hyperphosphatemia and supplementation of active vitamin D.