Kidney disease is a common, complex, costly and life-limiting condition. Most kidney disease registries or information systems have been limited to single institutions or regions. A national United States Department of Veterans Affairs (VA) Renal Information System (VA-REINS) was recently developed. We describe its creation and present key initial findings related to CKD without kidney replacement therapy (KRT). Data from VA’s Corporate Data Warehouse were processed and linked with national Medicare Data on CKD patients receiving KRT. Operational definitions for ‘VA user’, chronic kidney disease (CKD), acute kidney injury (AKI), and kidney failure were developed. Among seven million VA users in fiscal year 2014, CKD was identified using either a ‘strict’ or a ‘liberal’ operational definition, in 1.1 million (16.4%) and 2.5 million (36.3%) veterans, respectively. Most were identified using an eGFR laboratory phenotype, some via proteinuria assessment, and very few via ICD-9 coding. The VA spent approximately $18 billion for the care of patients with CKD without KRT, the majority of which was for CKD Stage 3, with higher per-patient costs by CKD stage. VA-REINS can be leveraged for disease surveillance, population health management, improving quality and value of care, thereby enhancing VA’s capacity as a patient-centered learning health system for US veterans.Copyright © 2020. Published by Elsevier Inc.