For Barbara Morrison, the decision is simple - dialysis or death.

The 75-year-old Aiken resident is one of nearly 500,000 Americans with end stage renal disease, otherwise known as kidney failure. She must go to a dialysis center three times a week to have toxins removed from her blood.

"If I didn't have it, I wouldn't be living. It's my lifeline," said Ms. Morrison, who suffers from high blood pressure.

Dialysis centers, though expensive to build and operate, are becoming increasingly common in the United States amid skyrocketing incidents of type 2 diabetes and hypertension - largely preventable ailments that are the most common causes of kidney failure.

The National Institutes of Health predicts the number of people with kidney failure is expected to reach 20 million by 2030.

The Augusta area, home to about a dozen dialysis centers, soon will have more on the way.

The Medical College of Georgia has joined with the Tennessee-based National Renal Alliance to build up to four new centers, and in the Aiken area, the Maryland-based Dialysis Corp. of America is expanding.

Kidney dialysis centers, which often operate as storefront facilities far from hospitals, have more than doubled in the United States, from 2,154 in 1991 to 4,432 in 2002, the most recent year for which figures are available.

DEMAND FOR DIALYSIS CENTERS is especially strong because there simply "are not enough kidneys" available for transplants, said Dr. William Paulson, the director of the End Stage Renal Disease Program at MCG.

Construction on the first of the proposed National Renal Alliance dialysis centers, a $1 million facility on Deans Bridge Road, will begin in September, company spokeswoman Kim Rucker said.

"There are a large number of dialysis patients in that area. Georgia and South Carolina are one of those areas in the United States that has a very high prevalence rate," she said.

The demand in Aiken and Edgefield counties has spurred an expansion by Dialysis Corp. of America, which is building a center in Edgefield and a second Aiken location.

"I think they feel there are more patients in that region, that perhaps are more interested in staying closer to home if they had a nicer facility," said Dr. Douglas Stahura, a kidney specialist who serves as medical director of Dialysis Corp.'s facilities in Aiken, Edgefield and Barnwell counties.

There also has been an increased effort to serve kidney disease patients in rural areas, said Dr. Stahura, who practices at CSRA Renal Services in Aiken.

"We're trying to do a better job overall," including efforts to educate, catch kidney problems early and prepare kidney-failure patients for treatment, he said.

CSRA Renal Services will add a third nephrologist in September and then open satellite offices in Edgefield and Barnwell counties.

Fresenius, a major national dialysis provider with five locations in Augusta, is expanding its rural reach with a new location in Warren County.

TYPE 2 DIABETES and high blood pressure can often be prevented by healthy eating and regular exercise, said Marry Harris, a spokeswoman for the Maryland-based National Institute of Diabetes and Digestive and Kidney Diseases.

But many Americans aren't making healthy choices, said University of Georgia demographer Douglas C. Bachtel.

"Georgia has one of the fastest rates of growth in diabetes of any state because we have a large poverty-stricken population, low levels of education and a high minority population," he said.

The abundance of overeaters and couch potatoes, combined with an aging population, has created a growing segment of the population that has little choice but to go on dialysis.

"It's an expensive process, but it's also a life-sustaining process," said Anton Hie, a Nashville, Tenn.-based dialysis industry analyst for Jefferies & Co.

Private health insurance can cover treatments for up to 30 months, but the majority of dialysis in the United States is paid for by Medicare.

In 2002, dialysis cost taxpayers $25.2 billion. Some say the government is not paying enough.

Insufficient reimbursements have made it difficult for small dialysis centers to expand, said Maureen Michael, the president of the National Renal Administrators Association, who is employed by a small company in Florida.

"To increase our reimbursements you have to literally have an act of Congress," she said.

THE COMPANIES best able to profit are the major chains, such as DaVita Inc. and Fresenius AG, which take advantage of economies of scale, Mr. Hie said.

To extend their reach and keep costs low, the major players in the dialysis industry have been buying up smaller companies around the nation. DaVita, for instance, recently purchased Gambro AB, which has several area locations.

"That works out for the patient as well, because providers share best practices across a national network of centers," Mr. Hie said.

Reach Adrian Burns at (706) 823-3352 or adrian.burns@augustachronicle.com.