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Background: Previous clinical trials showed that progression of coronary artery calcification (CAC) may be slower in hemodialysis patients treated with sevelamer than those treated with calcium-based phosphate binders. Because sevelamer decreases low-density lipoprotein cholesterol (LDL-C) levels, we hypothesized that intensive lowering of LDL-C levels with atorvastatin in hemodialysis patients treated with calcium acetate would result in CAC progression rates similar to those in sevelamer-treated patients., Study Design: Randomized, controlled, open-label, noninferiority trial with an upper bound for the noninferiority margin of 1.8., Setting & Participants: 203 prevalent hemodialysis patients at 26 dialysis centers with serum phosphorus levels greater than 5.5 mg/dL, LDL-C levels greater than 80 mg/dL, and baseline CAC scores of 30 to 7,000 units assessed by means of electron-beam computed tomography., Interventions: 103 patients were randomly assigned to calcium acetate, and 100 patients to sevelamer for 12 months to achieve phosphorus levels of 3.5 to 5.5 mg/dL. Atorvastatin was added to achieve serum LDL-C levels less than 70 mg/dL in both groups., Outcomes & Measurements: The primary end point was change in CAC score assessed by means of electron-beam computed tomography., Results: After 12 months, mean serum LDL-C levels decreased to 68.8 +/- 22.0 mg/dL in the calcium-acetate group and 62.4 +/- 23.0 mg/dL in the sevelamer group (P = 0.3). Geometric mean increases in CAC scores were 35% in the calcium-acetate group and 39% in the sevelamer group, with a covariate-adjusted calcium acetate-sevelamer ratio of 0.994 (95% confidence interval, 0.851 to 1.161)., Limitations: Treatment assignment was not blinded. The 1.8 a priori margin is large, CAC is a surrogate outcome, duration of treatment was short, and dropout rate was high., Conclusions: With intensive lowering of LDL-C levels for 1 year, hemodialysis patients treated with either calcium acetate or sevelamer experienced similar progression of CAC.

This study examined 12-month test-retest reliability of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in cocaine-dependent patients. Thirty-one patients completed the SCID-II during the second week of hospitalization for cocaine dependence, and again 12 months later. In both interviews, patients were asked to answer questions about their personality during the several years preceding admission to the hospital. Test-retest reliability, as measured by kappa, was relatively poor at .46. However, reliability of negative diagnoses (the absence of a disorder at both time points) was higher than reliability of positive diagnoses (the presence of a disorder at both time points). Reasons for the difficulty in attaining long-term test-retest reliability of axis II diagnoses in cocaine-dependent patients are discussed.