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Response to: ‘The reference levels of serum urate for clinically evident incident gout’ by Chen and Ding
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  1. Nicola Dalbeth1,
  2. Amanda Phipps-Green2,
  3. Christopher Frampton3,
  4. Tuhina Neogi4,
  5. William J Taylor5,
  6. Tony R Merriman2
  1. 1 Department of Medicine, University of Auckland, Auckland, New Zealand
  2. 2 Department of Biochemistry, University of Otago, Dunedin, New Zealand
  3. 3 Department of Medicine, University of Otago, Christchurch, New Zealand
  4. 4 Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Medicine, University of Otago, Wellington, New Zealand
  1. Correspondence to Prof Nicola Dalbeth, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland 1023, New Zealand; n.dalbeth{at}auckland.ac.nz

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We thank Drs Chen and Ding1 for their interest in our recent paper describing the relationship between serum urate concentrations and risk of developing incident gout.2 They suggest that we calculate benchmark dose estimates for serum urate and gout risk. Benchmark dose estimates are used in the field of occupational epidemiology to evaluate the minimal levels of exposure to an environmental toxin needed to cause a prespecified increase in an adverse event.

We are not aware of this approach being applied to clinical parameters that are not external exposures and are uncertain about validity of such an approach for serum urate, noting that all humans have some ‘exposure’ to urate, which is a circulating biochemical analyte. Estimation of the benchmark dose also requires a predetermined increase in risk (eg, 10% extra risk or change in the mean equal to one SD). At present, the clinically meaningful increase in gout risk is unknown. For these reasons, we have not provided benchmark dose estimates.

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Footnotes

  • Handling editor Josef S Smolen

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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