- What the Certified Hemodialysis Nurse Credential Is
- Who Qualifies to Sit for the Exam
- Exam Format and Scoring Mechanics
- The Four Domains and Where the Points Are
- Fees, Authorization, and Scheduling Mechanics
- Sequencing Your Prep Around the Domain Weights
- Where the Credential Gets Used
- Keeping the Credential Active After You Pass
- Frequently Asked Questions
- The CHN is issued by BONENT and tests 150 multiple-choice questions over three hours.
- Passing is a scaled score of 70 on a 1-100 scale, not a raw 70% correct.
- Dialysis and Related Issues carries 74.5% of the exam, so it should dominate your prep.
- Standard eligibility: RN plus one year of nephrology experience, or LPN/LVN plus two years.
What the Certified Hemodialysis Nurse Credential Is
CHN, as used throughout this site, stands for Certified Hemodialysis Nurse. It is awarded by the Board of Nephrology Examiners Nursing & Technology (BONENT) and is aimed at nurses who deliver hemodialysis care to patients with end-stage renal disease (ESRD). If you want a plain-language primer on the name itself, see What Is CHN Certification? or What Does CHN Stand For?.
The credential is narrowly focused. It does not certify general nursing knowledge, and it does not certify broad nephrology practice across every setting. It certifies that you can safely and competently run the hemodialysis treatment process, manage the people and environment around it, and keep your own professional practice current. That narrow focus is exactly why the exam rewards hands-on dialysis familiarity far more than textbook generalities.
Who Qualifies to Sit for the Exam
BONENT sets eligibility around two things: your nursing license and your time working with ESRD patients. The standard route has two tracks depending on licensure:
- Registered nurses: an eligible RN license plus one year of nephrology experience.
- LPN/LVN candidates: an eligible LPN/LVN license plus two years of nephrology experience.
In both cases, the experience must involve active work with ESRD patients, and your application requires two signed references. There is also an approved corresponding nurse-training pathway for candidates who complete qualifying training instead of following the standard experience route. That pathway requires BONENT confirmation and supporting documentation, so contact the board before assuming your training qualifies.
For a fuller walkthrough of documentation, references, and edge cases, read CHN Requirements 2026: Eligibility, Prerequisites & How to Qualify. A practical tip: line up your two reference signers early. Delays collecting signatures are one of the most common reasons candidates miss a testing window.
Exam Format and Scoring Mechanics
The numbers that define test day
| Feature | CHN Detail |
|---|---|
| Question count | 150 multiple-choice questions |
| Time allowed | 3 hours |
| Passing standard | Scaled score of 70 on a 1-100 scale |
| Open/closed book | Closed book |
| Personal calculators or reference devices | Not permitted under the linked handbook |
| Delivery | Computer-based testing (CBT) or paper under approved onsite proctoring |
| Accommodations | Available through the board |
What "scaled score of 70" really means
This is the detail candidates misread most often. The passing mark is a scaled score of 70 on a 1-100 scale. It is not a verified 70% raw score, so you cannot reliably convert it into "I need to get 105 of 150 right." BONENT also does not publish how many questions are scored versus unscored, and a public pass rate is not disclosed. Treat any website that quotes a precise raw cutoff or a pass percentage as unverified. For a deeper look, see CHN Passing Score 2026: Exactly What You Need to Pass and CHN Pass Rate 2026: What the Data Shows.
The practical takeaway: aim for comfortable mastery rather than a bare minimum. Because the scoring conversion is scaled and the scored/unscored split is undisclosed, there is no safe way to "game" a target number.
Closed book, no devices, no shortcuts
The exam is closed book, and the linked handbook does not allow personal calculators or reference devices. That has a direct study implication: any dialysis math you need, such as reasoning about treatment parameters or fluid-related calculations, must be something you can do by hand and understand conceptually. CBT is also not a verified at-home route, so plan on testing at an approved site or proctored onsite paper session rather than from your kitchen table.
The Four Domains and Where the Points Are
The official PDF outline divides the exam into four domains totaling 100%. The distribution is extremely lopsided, which should shape your entire plan. A full treatment of each area lives in CHN Exam Domains 2026: Complete Guide to All 4 Content Areas; here is the strategic overview.
| Domain | Weight | Strategic Read |
|---|---|---|
| Domain 1: Supervision/Management | 10% | Leadership, delegation, and oversight of dialysis care |
| Domain 2: Dialysis and Related Issues | 74.5% | The core of the exam; most of your time belongs here |
| Domain 3: Professional Development | 5.5% | Smallest slice; cheap points if you review it once carefully |
| Domain 4: Environmental Control | 10% | Water, equipment, and infection-control-related safety topics |
Domain 2: Dialysis and Related Issues (74.5%)
Nearly three of every four questions come from here. This domain covers the clinical substance of hemodialysis: the treatment itself, the patient receiving it, and the problems that arise around it.
- Pre-, intra-, and post-dialysis assessment and what each finding means for the treatment plan
- Vascular access care, surveillance, and complication recognition
- Recognizing and responding to intradialytic complications
- The physiology behind ESRD and how treatment prescriptions address it
- Medications, anemia and mineral-bone considerations, and patient education related to dialysis care
Domain 1: Supervision/Management (10%)
This domain tests how you organize and oversee care, not just deliver it. Expect scenario-style thinking about who does what and how a unit runs safely.
- Delegation and scope-of-practice boundaries among nursing and technical staff
- Quality and safety oversight within a dialysis unit
- Staff communication and accountability
Domain 4: Environmental Control (10%)
Hemodialysis exposes patients' blood to treated water and complex equipment, so this domain examines the systems and practices that keep that exposure safe.
- Water treatment and its importance to patient safety
- Equipment preparation, maintenance, and disinfection principles
- Infection prevention practices specific to the dialysis setting
Domain 3: Professional Development (5.5%)
The smallest domain, but it deserves one focused review pass because the points are easy to secure.
- Standards of practice and professional accountability
- Continuing education and staying current in nephrology nursing
Fees, Authorization, and Scheduling Mechanics
BONENT publishes a flat fee structure with no member versus non-member tiers. The amounts depend on delivery mode and where you are located:
| Location | Paper Exam | CBT |
|---|---|---|
| United States | USD 235 | USD 255 |
| International | USD 260 | USD 255 |
An optional USD 100 expedite fee is available if you need faster processing. Keep in mind that your application must be approved and you must receive authorization before you can schedule, and both authorization and application deadlines apply. The linked general handbook (revised January 2021) predates current pricing, so rely on the live BONENT webpage for fees rather than any older PDF. Our CHN Certification Cost 2026: Complete Pricing Breakdown adds study materials and renewal costs to the picture, and CHN Exam Dates 2026: Testing Windows, Deadlines & Scheduling covers timing.
Key Takeaway
Work backward from the application deadline, not the exam date. Reference signatures, license verification, and authorization all happen before you can book a seat, and the optional expedite fee is a rescue tool, not a plan.
A note on outline and handbook versions
The current detailed exam outline is undated, and the general handbook linked from BONENT was revised in January 2021. The 2026 renewal booklet is about maintaining the credential and is not an exam-version update. In other words, don't assume a newly dated document means the test content changed. Anchor your study to the four official domain weights above and confirm anything uncertain directly with the board.
Sequencing Your Prep Around the Domain Weights
BONENT does not mandate a universal number of prep hours, so your timeline depends on how recently you have worked through the full range of dialysis situations. What the domain weights do dictate is order and proportion. Here is a sample sequence that follows the exam blueprint rather than generic study habits. For a fuller plan, see the CHN Study Guide 2026: How to Pass on Your First Attempt.
Domain 2 foundations
- Rebuild the physiology behind ESRD and the treatment prescription
- Review vascular access types, assessment, and complications
- Practice dialysis-related calculations by hand, since no calculator is allowed
Domain 2 scenarios
- Work intradialytic complication scenarios until your response order is automatic
- Cover medications and patient-education content tied to dialysis care
Domains 4 and 1
- Study water treatment, equipment, and infection-control principles
- Review delegation, oversight, and unit safety management
Domain 3 and full-length practice
- One focused pass through Professional Development
- Take a timed 150-question practice set at the three-hour limit and review every miss
The logic is simple: Domain 2 earns the bulk of your score, so it gets the bulk of your calendar and returns again through mixed practice. Domain 3 is small enough to review in a short block, but skipping it entirely leaves easy points on the table. Use the CHN Cheat Sheet 2026: One-Page Review of Must-Know Facts for last-week consolidation, and run timed sets on our CHN practice test to build pacing for the 150-question, three-hour format.
How hard will it feel?
Because the pass rate is not publicly disclosed, no one can honestly quote you a difficulty percentage. Candidates with daily bedside dialysis exposure usually find the clinical content familiar and the challenge lies in the precise phrasing of multiple-choice items and in the less-practiced management and environmental areas. We discuss this in How Hard Is the CHN Exam? Complete Difficulty Guide 2026.
Where the Credential Gets Used
Certified Hemodialysis Nurses work wherever hemodialysis is delivered. Typical settings include:
- Outpatient dialysis facilities, including those run by large dialysis organizations and independent providers
- Hospital-based dialysis units, serving inpatients and acute needs
- Home and training programs, where nurses teach patients to dialyze outside a facility
- Leadership and educator roles, where the Supervision/Management domain content becomes day-to-day work
The certification signals specialized competence to employers and can support advancement into charge, educator, or management positions. Whether it translates into higher pay depends on your employer, region, and role, and we avoid quoting unverified figures. For discussion of the earnings picture and the broader return, see CHN Salary Guide 2026: Complete Earnings Analysis and Is the CHN Certification Worth It? Complete ROI Analysis 2026. If you are scouting openings, CHN Jobs outlines where the credential is requested.
Keeping the Credential Active After You Pass
The CHN is valid for four years. To renew, you generally choose between these routes:
- Contact hours: 40 contact hours, at least 30 of which must be in nephrology.
- Examination or waiver route: retaking a qualifying examination, or using a once-in-lifetime waiver where eligible.
There is also a maintenance fee: USD 65 per year, or USD 240 if you prepay for all four years. Prepaying saves a modest amount over paying annually, so decide based on your budget and job stability. Start logging nephrology-specific education from the day you certify. Collecting 30 qualifying nephrology hours over four years is easy when tracked steadily and painful when left for the final months. For background on training options that can count toward your development, visit CHN Training.
Frequently Asked Questions
The Board of Nephrology Examiners Nursing & Technology (BONENT) administers the exam and issues the credential. For a broader orientation to the term, see What Is A CHN?.
The exam has 150 multiple-choice questions with a three-hour time limit. BONENT does not disclose how many of those questions are scored versus unscored, so answer every question with equal care.
Not exactly. The standard is a scaled score of 70 on a 1-100 scale, which is not a verified 70% raw score. You cannot reliably translate it into a fixed number of correct answers out of 150.
Dialysis and Related Issues, which makes up 74.5% of the exam. Supervision/Management and Environmental Control are 10% each, and Professional Development is 5.5%.
An at-home route is not verified. The exam is delivered by computer-based testing through a linked testing network or as a paper exam under approved onsite proctoring, and it is closed book with no personal calculators or reference devices allowed.
If you are ready to begin building exam-style speed and accuracy, start with timed sets on the CHN Exam Prep practice test platform, and keep this article's domain breakdown beside you as your map.