Furthermore, Japanese patients with glomerulonephritis showed a significant faster mean age increment among incident patients with ESRD than US patients with glomerulonephritis.14 Boulware et al.17 reported FK506 that annual screening for proteinuria in US adults was not cost-effective because the prevalence and incidence of proteinuria were very low. However, selective annual testing focusing on high-risk groups is highly cost-effective. They reported that annual screening starting at age

60 years or older is cost-effective for persons with neither hypertension nor diabetes, and annual screening from ages 30–70 years is highly cost-effective for persons with hypertension.17 The prevalence of proteinuria in Japanese adults with neither hypertension nor diabetes was almost equal to the prevalence of proteinuria in US adults with hypertension of the same age group.18 Most of these subjects have no symptoms and the only sign of renal disease is asymptomatic urinary

abnormalities. The Malay race, a Southeast Asian population, also showed a high prevalence of proteinuria.19 Consequently, annual urinalysis for general population Asians may be cost-effective. Both proteinuria and impaired renal function predict a worse prognosis with respect to cardiovascular morbidity and mortality.20 Subjects with proteinuria showed three times faster glomerular

filtration rate (GFR) loss than both control and impaired renal function subjects.21 Therefore, proteinuria is a better risk marker than impaired renal function BYL719 in population screening of individuals to identify who is at risk for developing ESRD. Some people proposed that universal testing for microalbuminuria should be considered. However, the prevalence of microalbuminuria in mass screening was quite different among races and countries, which had a several times higher positive rate in Japan compared to that in the USA.22 The cost for urinary Inositol oxygenase albumin and creatinine ratio testing is more expensive than the urine dip-stick test for proteinuria. Consequently, universal screening with the urine dip-stick test for proteinuria is suitable for most countries or races that have a high prevalence of proteinuria like Asians and Japanese. However, there are lifestyle modifications, along with a higher prevalence of diabetes in the general population, and higher incidence of stroke and stroke mortality in Japan; therefore, we might have to change urinalysis screening policy from the urine dip-stick test for proteinuria to microalbuminuria in the near future. According to the Bureau of National Health Insurance (BNHI) annual report in 2007, patients with ESRD in Taiwan accounted for 0.23% of the local population but spent 7.2% of the health-care resources.