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Kibum Kim,1– 3 Jacob Crook,3,4 Chao-Chin Lu,3 Heather Nyman,2 Abdullah Abdelaziz,1 Joanne LaFleur2,3 1Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA; 2Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 3VA Salt Lake City Health Care System, Salt Lake City, UT, USA; 4Division of Epidemiology, University of Utah, Salt Lake City, UT, USACorrespondence: Kibum Kim, Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, 833 S. Wood Street | Rm 256 PHARM, MC 871, Chicago, IL, 60616, USA, Tel +1 (312) 413-0152, Email kkim204@uic.eduRationale: With a large number of patients and high mortality, diabetic kidney disease (DKD) imposes a significant burden on US health care. Although diabetes is the leading cause of chronic kidney disease and complications, the epidemiology of DKD in the contemporary US veteran population is generally unknown.Objective: We aimed to estimate the rate of DKD progression and to measure the general epidemiology of DKD in the United States veteran population.Study Design: We performed a retrospective observational research using electronic health-care records and administrative databases.Setting: The DKD patient cohort was abstracted from the Veterans Health Administration health-record data from January 2016 to March 2022.Participants: We defined DKD patients using the laboratory test data based on Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines.Analytic Approach: Summary statistics include the five-year cumulative incidence of progression to an advanced stage from the DKD stage at the cohort entry date and prevalence at a series of single time points.Results: A total of 685,288 patients (male [96%], mean age 62 years, Caucasian [64%], non-Hispanic [87%]) met our eligibility criteria. The 5-year cumulative incidence of progression to an advanced DKD stage or all-cause death from DKD stages G1 A2/A3, G2 A2/A3, G3a, and G3b were 52.0%, 47.4%, 50.5%, and 60.9%, respectively. In sum, 594,082 patients were classified as moderate or high risk as per KDIGO guidelines in 2021, and stages G3a and G3b accounted for 51.2% and 25.3%, respectively, of cases.Conclusion: More than half of DKD patients underwent a stage progression or death within 5 years. A substantial number of DKD patients at an earlier stage might be left undetermined. The study findings warrant a revision of DKD patient identification and management in US veterans.Keywords: diabetic kidney disease, prevalence, US veterans

California currently recycles treated wastewater at a volume of approximately 8.0×108 m3 of water per year, with a potential to recycle an additional 1.9×109 m3 per year. A key challenge in promoting the expansion of water recycling for agricultural purposes was addressing the perceived concern about whether recycled water produced in conformance with California law is protective of public health. The California Department of Public Health (CDPH) established an expert panel to consider the concern. The panel found, based on quantitative microbial risk assessment (QMRA), that the annualized median risks of infection for full tertiary treatment ranges from 10-8 to 10-4 (for human enteric viruses Cryptosporidium parvum and Giardia lamblia, and Escherichia coli O157:H7) based on the assumption of daily exposure. The panel found that risk estimates are consistent with previous CDPH estimates and concluded that current agricultural water recycling regulations do not measurably increase public health risk. © 2014 American Society of Civil Engineers.