- The Exam at a Glance
- Who Can Sit for It
- Fees, Delivery and Application Mechanics
- Domain Weights: Where the Points Live
- Dialysis and Related Issues: The Core Topics
- Domains 1, 3 and 4: Smaller but Not Skippable
- Scoring Facts Worth Memorizing
- Exam-Day Rules and Accommodations
- Sequencing Your Review by Domain
- After You Pass: Validity, Renewal and Maintenance
- Frequently Asked Questions
- The Certified Hemodialysis Nurse exam is administered by BONENT: 150 multiple-choice questions in 3 hours, closed book.
- Dialysis and Related Issues carries 74.5% of the content, so most of your study time belongs there.
- The passing mark is a scaled score of 70 on a 1-100 scale, not a verified 70% raw score.
- Certification is valid four years; standard renewal requires 40 contact hours, at least 30 in nephrology.
The Exam at a Glance
This page condenses what a Certified Hemodialysis Nurse candidate needs to know into a single scannable reference. The credential is awarded by the Board of Nephrology Examiners Nursing & Technology (BONENT), and everything below applies to that credential specifically. If you are still deciding whether to pursue it, start with What Is CHN Certification?; if you are ready to begin practicing, the CHN practice test is the fastest way to find your weak spots.
| Item | What to Know |
|---|---|
| Certifying body | Board of Nephrology Examiners Nursing & Technology (BONENT) |
| Question count | 150 multiple-choice questions |
| Scored vs. unscored split | Not disclosed |
| Time limit | 3 hours |
| Passing standard | Scaled score of 70 on a 1-100 scale |
| Pass rate | Not publicly disclosed |
| Format | Computer-based testing (CBT) or paper under approved onsite proctoring |
| Reference materials | Closed book; no personal calculators or reference devices |
| Certification validity | Four years |
Because the scored/unscored split is undisclosed, treat every one of the 150 items as if it counts. There is no safe place to coast.
Who Can Sit for It
Eligibility is built around licensure plus hands-on nephrology time. The standard route has two tiers:
- RN pathway: an eligible RN license and one year of nephrology experience.
- LPN/LVN pathway: an eligible LPN/LVN license and two years of nephrology experience.
In both cases the experience must involve active work with end-stage renal disease (ESRD) patients, and you need two signed references. An approved corresponding nurse-training pathway also exists, but it requires confirmation from BONENT and supporting documentation, so contact the board before assuming you qualify through that route. No universal mandatory prep-hour total has been verified, which means no one can tell you a required number of study hours. The full eligibility walkthrough lives in CHN Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Fees, Delivery and Application Mechanics
BONENT publishes a straightforward fee structure with no member/non-member tiers. The numbers below are the ones to remember:
| Candidate Type | Paper Exam | CBT Exam |
|---|---|---|
| U.S. | USD 235 | USD 255 |
| International | USD 260 | USD 255 |
An optional USD 100 expedite fee is also available if you need faster processing. Note that the linked general handbook was revised in January 2021 and its fee figures have been superseded by the current BONENT webpage, so always trust the live fee page over any older PDF. For the full cost picture, including renewal costs, see CHN Certification Cost 2026: Complete Pricing Breakdown.
How Delivery Works
Computer-based testing runs through a linked SMT/IQT network, while paper examinations are offered under approved onsite proctoring. CBT is not a verified at-home route, so plan on testing at an approved location rather than from your kitchen table. Authorization and application deadlines apply, which makes timing as important as readiness; CHN Exam Dates 2026: Testing Windows, Deadlines & Scheduling covers the calendar side in detail.
Domain Weights: Where the Points Live
The four official PDF domains total 100%, and the distribution is dramatically lopsided. Here is the one-line version of the blueprint:
| Domain | Weight |
|---|---|
| Domain 1: Supervision/Management | 10% |
| Domain 2: Dialysis and Related Issues | 74.5% |
| Domain 3: Professional Development | 5.5% |
| Domain 4: Environmental Control | 10% |
One naming wrinkle to know: the official PDF calls Domain 1 "Supervision/Management," while the BONENT website overview refers to it as "Supervision/Administration." They describe the same content area, so don't be thrown if you see either label. Also note that the detailed exam outline itself is undated, and the 2026 renewal booklet is not an exam-version update, so avoid assuming the blueprint changed just because a new booklet appeared. For a deeper breakdown of each area, read CHN Exam Domains 2026: Complete Guide to All 4 Content Areas.
Key Takeaway
Roughly three of every four questions come from Dialysis and Related Issues. A candidate who is excellent at Domains 1, 3 and 4 but shaky on direct dialysis care is still in trouble; the reverse is a far safer position.
Dialysis and Related Issues: The Core Topics
At 74.5%, this domain is the exam. It covers the clinical substance of caring for hemodialysis patients, and it is where the most-tested patient-care material sits. Rather than guessing at a topic list, anchor your review to the official outline and use this domain box as a prompt for the areas you should be able to explain fluently.
Domain 2: Dialysis and Related Issues (74.5%)
This is the clinical heart of the credential. Expect questions that test judgment at the chairside, not just recall of definitions.
- The hemodialysis treatment process, from pre-treatment assessment through post-treatment care
- Vascular access care and the complications that can arise with it
- Recognizing and responding to intradialytic problems
- Patient assessment and monitoring across the course of treatment
- Conditions and complications related to ESRD and its management
- Medications and treatments commonly encountered in the dialysis setting
- Patient education and care across the ESRD population
The question style is multiple choice, and the clinical items tend to reward applied reasoning: what should the nurse do first, which finding warrants intervention, which action is most appropriate. Practice with scenario-style questions rather than flashcards alone. Candidates sometimes underestimate how much of the difficulty comes from this domain's sheer breadth; How Hard Is the CHN Exam? Complete Difficulty Guide 2026 unpacks that further.
Domains 1, 3 and 4: Smaller but Not Skippable
Together these three domains account for 25.5% of the exam, which is roughly one quarter of your score. That is far too much to ignore, especially because the passing standard is a scaled score and you cannot know exactly how many items you can afford to miss.
Domain 1: Supervision/Management (10%)
Focuses on the leadership and organizational side of running a dialysis care environment.
- Delegation and supervision of care
- Staffing, coordination and unit-level management responsibilities
- Quality and compliance expectations in the dialysis setting
Domain 3: Professional Development (5.5%)
The smallest domain, covering the nurse's growth and role within the profession.
- Continuing education and maintaining competence
- Professional responsibilities and standards of practice
- Your own pathway for maintaining certification over time
Domain 4: Environmental Control (10%)
Addresses the safety and infrastructure side of the dialysis environment.
- Infection prevention and control practices
- Safe operation and monitoring of the treatment environment
- Water and equipment-related safety considerations
Because these domains are weighted evenly with or below Domain 1, they are efficient places to pick up points. A modest, steady investment in them often pays off more per hour than endlessly polishing material you already know in Domain 2.
Scoring Facts Worth Memorizing
Scoring is the most commonly misunderstood part of this credential, so it earns its own section.
- The passing score is 70 on a scaled 1-100 range. It is a scaled score, not a verified 70% raw score. Do not assume that answering 105 of 150 questions correctly equals a pass.
- The pass rate is not publicly disclosed. Any specific percentage you see quoted online is not backed by an official BONENT figure.
- The scored/unscored split is undisclosed. You cannot tell which items count, so treat them all seriously.
Exam-Day Rules and Accommodations
The exam is closed book. Under the linked handbook, personal calculators and reference devices are not permitted, so any math you need to do must be handled mentally or with whatever the testing environment provides. Practice working through calculation-style questions without leaning on your phone or a handheld calculator.
Accommodations are available for candidates who need them, but like everything else in this process they involve authorization and application deadlines. Request them early rather than the week of your exam. Because testing happens at approved onsite or network locations, confirm your site, arrival requirements and identification rules well ahead of time.
Sequencing Your Review by Domain
Study method is not the point of this page, but sequencing is worth a brief note because the domain weights make the order of attack unusually clear. Front-load the heavy domain, then use the smaller domains to round out coverage. A broader plan is laid out in CHN Study Guide 2026: How to Pass on Your First Attempt.
Dialysis and Related Issues, Part One
- Cover the treatment process and patient assessment first, since these underpin everything else
- Work scenario questions, not just notes
Dialysis and Related Issues, Part Two
- Move to access care, complications and ESRD-related conditions
- Revisit the questions you missed in Block 1
Environmental Control and Supervision/Management
- Together these are 20% of the exam and are mostly policy and safety knowledge, which memorizes well
Professional Development plus full-length practice
- Cover the smallest domain quickly
- Spend remaining time on timed 150-question practice runs to build 3-hour pacing
After You Pass: Validity, Renewal and Maintenance
Certification is valid for four years. Standard renewal requires 40 contact hours, including at least 30 nephrology hours. Alternatively, you can renew through a qualifying examination or a once-in-lifetime waiver route. Maintenance fees are USD 65 annually, or USD 240 prepaid for the full four years; prepaying works out to a lower total than four annual payments of USD 65, which would come to USD 260.
If you are weighing the return on all of this, the career-side questions are covered in CHN Salary Guide 2026: Complete Earnings Analysis, Is the CHN Certification Worth It? Complete ROI Analysis 2026, and CHN Jobs. In practice, the nurses who hold this credential work in hemodialysis settings where ESRD care is delivered, which is exactly the environment the exam is designed around.
Frequently Asked Questions
The exam has 150 multiple-choice questions to be completed in 3 hours. BONENT does not disclose how many of those items are scored versus unscored, so you should answer every question as though it counts.
No. The passing standard is a scaled score of 70 on a 1-100 scale. It is not a verified 70% raw score, so you cannot convert it into a fixed number of correct answers out of 150.
Dialysis and Related Issues, which accounts for 74.5% of the exam. The other three domains are Supervision/Management (10%), Environmental Control (10%) and Professional Development (5.5%), so they matter but carry far less weight.
CBT is not a verified at-home route. Testing is delivered through a linked SMT/IQT network for computer-based exams, with paper examinations offered under approved onsite proctoring. Plan to test at an approved location.
U.S. candidates pay USD 235 for paper or USD 255 for CBT. International candidates pay USD 260 for paper or USD 255 for CBT. An optional USD 100 expedite fee is available, and no member/non-member pricing tiers are published.
Use this sheet as a quick-reference anchor, then confirm any deadline, fee or eligibility detail against BONENT's current materials before you apply, since those are the details most likely to change. When you are ready to test your knowledge against realistic questions, head to the CHN Exam Prep practice test site and see where you stand across all four domains.