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Factors that may potentiate renal toxicity in an ICU setting, such as concomitant nephrotoxic medication, sepsis, shock, and hypoalbuminemia, should be adequately controlled.
It is mandatory to consider also other well-known risk factors for chronicization, such as psychiatric illness and life events, and other possible modifying features, such as concomitant medication and treatment adherence.
In order to determine reliable data regarding the clinical efficacy of CaPE, future trials should also match groups for potential confounding factors such as concomitant pharmacological treatment, duration of illness, and type of disorder (i.e., type I or type II).
Yet some contraindications to the practice are not subject to debate, such as concomitant use of neuromuscular blocking agents.
Also, retrieval of data on possible confounders such as concomitant medication, height and smoking status was not possible.
Data collected after randomisation such as concomitant medical therapy, continuing steroid treatment, and azathioprine or other immunosuppressive therapy.
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Opportunity exists to explore methods to enhance lesional absorbed dose such as the concomitant use of drug therapy which may radiosensitize tumours (e.g. chemotherapy +/− anti-EGFR monoclonal antibodies or bevacizumab).
Also, factors such as other concomitant diseases, parity or sexual activity could not be considered.
Whether probiotics can help to improve efficacy of treatments such as the concomitant treatment, or other treatments, needs more research.
Also, information on relevant data such as comorbidity, concomitant use of other drugs and folic acid supplementation were often not available.
However, the effect was found to be moderate and could be easily overcompensated by other electronic effects, such as the concomitant increase in alcohol HB donating capacity.
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