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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.
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.