OBJECTIVES Cardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). Vascular calcification (VC) is a common feature of CKD that predicts mortality and may contribute to future outcomes. CKD treatment guidelines recommend that calcium-based phosphate binders (CBBs) be restricted to doses of 1.5 g/day elemental calcium, however a previous study showed that this dose was associated with VC in CKD. Similarly, the use of calcium (<1.5 g/day) has been associated with poorer cardiovascular outcomes in other patient populations (e.g., postmenopausal women). The aim of this review was to compare the prevalence of VC among CKD patients treated with CBBs and sevelamer. METHODS A literature search using Medline was conducted using the following terms: CBB, calcium carbonate, calcium acetate, non-CBB, sevelamer, lanthanum, vascular calcification, coronary and aorta. Studies reporting mean changes from baseline (%) in VC scores in CBB and sevelamer groups were used for data extraction. RESULTS Increased progression of coronary calcification was observed in CBB groups as compared to sevelamer: 13.4% to 50.8% vs. -8.0% to 23.4% (n=6 studies). Sevelamer was associated with regression of aortic calcification compared to CBBs: -71.3% to -13.4% vs. 5.7% to 135% (n=3 studies). Average doses of calcium ranged from 1.39 to 2.3 g/day. CONCLUSIONS Although the doses of elemental calcium used in these studies approached those recommended by treatment guidelines, CBBs were associated with increased progression of VC. CBBs are associated with increased VC, a predictor for mortality, even when calcium doses concur with current standards of practice. More research on the impact of CBBs on VC and future outcomes is required.