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Chances are good that you, or someone you love, will someday face the risk of kidney failure.

One in three Americans over age 20 has high blood pressure. An estimated 23.6 million of us, or 8 percent of the population, have diabetes. Those are the top two causes of kidney disease.

By the time symptoms emerge — changes in urination, nausea and vomiting or swelling in the face, hands or feet — serious damage has already taken place.

The disease usually hits later in life, but health officials worry that Americans' growing obesity rates and high-stress lifestyles mean it will begin affecting younger people.

The bottom line: You can't live without functioning kidneys, and the health conditions that can cause them to fail are rising fast.

"About one in nine adults has kidney disease and many of them don't know they have it," said Susan Price, CEO of one of the largest network of kidney specialists in the country, the Arizona Kidney Disease & Hypertension Center.

Kidneys are crucial

The kidneys, two fist-sized, bean-shaped organs in the middle of the back on both sides of the spine, filter deadly toxins from the body, help regulate blood pressure and make urine.

They're also crucial in the production of hemoglobins, which carry oxygen through the bloodstream.

If they fail, you will face difficult choices.

There's hemodialysis, a grueling process most commonly done in a medical center. Blood is drawn from the body, preferably from the arm, through a tube as thick as a pen, then fil tered through an artificial kidney, or dialyzer. The clean blood is returned to the body through another thick tube.

Another option — if you are healthy enough and lucky enough — is to hope for a kidney transplant from a living donor or a cadaver. The average wait for a kidney from a cadaver in Arizona is four to five years.

Or you can do nothing and, eventually, die.

Indians most vulnerable

About 485,000 Americans had been diagnosed with kidney failure as of late last year, and that number is expected to rise to 785,000 by 2020, says the American Society of Nephrology.

About 20 million Americans have some evidence of chronic kidney disease, which could eventually lead to renal failure, the society says.

Certain populations are vulnerable to the disease because of genetics, family history, cultural factors and lifestyle choices.

"When you think of diabetes, there is a high incidence in Native Americans and Hispanics, so because of those two populations we do have a high frequency of kidney disease in Southern Arizona," said Dr. Amit Fadia, a nephrologist who treats patients with kidney problems.

Some American Indian populations in Southern Arizona have the highest rates of diabetes in the world, health officials say.

In 2007, 6,747 Arizonans were on dialysis, a 38 percent increase from 2000, says the Intermountain End-Stage Renal Disease Network Inc., which collects data about those on dialysis for Medicare. The federal program foots the bill for most of those with the disease, even for those under the age of 65.

Last year, 2,079 patients were newly diagnosed in Arizona with end-stage renal disease, which is another name for kidney failure.

About 80 percent of those stricken with kidney failure are older than 50. The number of people on dialysis is increasing in part because people are living longer, said Dr. David Whittman, a nephrologist and associate clinical professor at the University of Arizona.

Patients who suffer a stroke or heart attack nowadays are more likely to survive, he said. Those people then become vulnerable to other ailments, such as kidney failure.

But with Type 2 diabetes — often considered a "lifestyle" disease — more frequently occurring in children, some health experts have new worries.

"What we're going to start seeing in the future is younger people on dialysis," said Karen Lucero, a Tucson dietitian who's worked with dialysis patients for the past seven years.

In 2007, about 15.7 percent of patients newly diagnosed with end-stage renal failure were between 30 and 49. Five years before, 13.2 percent of the newly diagnosed patients were in that age group.

Toxins accumulate

The main treatments of kidney failure are dialysis or transplant.

The first step when working with end-stage renal disease patients is to inform them of their options and what they can expect when they begin treatment, said Lee Cauble, nurse supervisor for the non-profit Desert Dialysis. They also need to know what kind of food to eat, as toxins will linger in their bloodstream.

Sometimes that information needs to be repeated, she said.

"There's a lot of concerns and worries they have when they learn they have to start (dialysis), and they don't often hear the information about diet, exercise and the importance of maintaining their health," Cauble said.

Most patients receive hemodialysis, a process in which blood is filtered in a Medicare-certified center. In Arizona, more than 90 percent of dialysis patients receive in-center care.

Three times per week, usually for about four hours, the patients are hooked up to a large machine, often by a large needle in their forearm, that cleans their blood.

The schedule can make it difficult for patients to keep a job, and the treatment is costly, though Medicare or private insurance plans usually cover most of the cost.

Dialysis patients sometimes feel fatigued and uncomfortable between visits as toxins accumulate in the body.

They don't urinate because their kidneys aren't functioning, so when they come into the center they are weighed, nephrologist Fadia said. Their weight and any swelling from fluid accumulation determines how long they will be dialyzed and how much fluid will be removed from their bloodstream.

It takes the artificial kidney several hours to do what a healthy one can do in minutes. And the dialyzer only removes a fraction of the toxins a healthy kidney would, experts say.

Do-it-yourself dialysis

Some nephrologists encourage patients with kidney failure to try peritoneal dialysis, which allows them to filter their blood at home. During continuous ambulatory peritoneal dialysis, fluid exchanges are done several times a day.

Using a soft catheter that's surgically implanted into the body, patients fill their abdomen with a dialysis solution that removes waste and excess fluid from the blood. The solution and waste product is drained from the body through the catheter and discarded.

Another at-home method, continuous cycling peritoneal dialysis, requires a machine that filters blood at night while the patient sleeps. Patients may also need to do daytime exchanges and their physician may recommend a combination of continuous ambulatory and continuous cycling peritoneal dialysis.

The ability of dialysis patients to filter their blood at home can let the younger ones keep a job and even travel. They can have supplies delivered to their destination.

Still, less than 10 percent of dialysis patients in Arizona undergo peritoneal dialysis. The rest are older with other ailments or prefer the setting of a dialysis center. At-home dialysis requires medical training and extensive monitoring, and it's a process many prefer to leave to professionals.

An agonizing choice

For many, deciding how to fight kidney failure comes down to their loved ones.

Sometimes even those working in dialysis centers wonder whether it's something they could handle, said Lucero, the dietician.

"Often times we tell each other we would never go on dialysis," she said.

But that can change when their viewpoint shifts from the theoretical to the practical.

Lucero's mother, who's in her late 80s, entered the fourth stage of kidney disease and her nephrologist began discussing dialysis. Lucero said her mother told her doctor straight out she wasn't interested in the treatment.

But Lucero wanted her mother to at least consider it.

"It really opened my eyes to why families want their relatives to do it," she said. "They don't want to lose their loved ones."