- CHN here means Certified Hemodialysis Nurse, administered by BONENT, not any other credential sharing the acronym.
- The exam has 150 multiple-choice questions over 3 hours, with a scaled passing score of 70.
- Dialysis and Related Issues carries 74.5% of the content outline, dwarfing the other three domains.
- RN candidates need one year of nephrology experience; LPN/LVN candidates need two, plus two signed references.
What CHN Means on This Site
The acronym "CHN" is shared by several unrelated credentials in healthcare and education, which is exactly why a search for it can send you in the wrong direction. On this site, CHN means Certified Hemodialysis Nurse: a nursing certification for licensed nurses who deliver hemodialysis care to patients with end-stage renal disease (ESRD). Nothing on this page applies to any other credential that happens to abbreviate to the same three letters, so if you arrived looking for a different CHN, the details below (the certifying body, the fees, the exam outline) will not match what you need.
If you want the shorter definitional versions of this topic, we also cover what CHN stands for and the plain-language CHN meaning. This article goes further: it explains how the certification is structured, who can sit for it, what it costs to get and keep, and what the exam actually tests.
Who Runs the Credential
The Certified Hemodialysis Nurse credential is administered by the Board of Nephrology Examiners Nursing & Technology (BONENT). BONENT is the certifying body for nephrology nursing and dialysis technology credentials, and it handles applications, eligibility review, exam delivery, scoring, and ongoing maintenance of the certification.
Computer-based testing (CBT) is delivered through a linked network of testing sites, and paper examinations are available under approved onsite proctoring. Because BONENT controls the application and authorization process, your first practical step as a candidate is always to confirm current requirements directly on the BONENT website rather than relying on older handbooks or third-party summaries.
Exam Format at a Glance
The CHN exam is a straightforward, traditional multiple-choice test. There are no simulations, essay prompts, or multi-step performance tasks to prepare for. What makes it demanding is the clinical breadth packed into a single sitting.
| Feature | Certified Hemodialysis Nurse Exam |
|---|---|
| Certifying body | BONENT |
| Question count | 150 multiple-choice questions |
| Time allowed | 3 hours |
| Passing standard | Scaled score of 70 on a 1-100 scale |
| Scored vs. unscored split | Not disclosed |
| Delivery | CBT (linked SMT/IQT network) or paper under approved onsite proctoring |
| Open or closed book | Closed book |
| Published pass rate | Not publicly disclosed |
What "scaled score of 70" really means
A common mistake is assuming the passing mark equals getting 70% of questions right. It does not. The passing standard is a scaled score of 70 on a 1-100 scale, and BONENT does not publish a raw-score conversion. Because the scored/unscored split is also undisclosed, you cannot calculate a safe number of questions you can miss. The only reliable strategy is to aim for solid mastery across the board. Our deeper explanation lives in the CHN passing score guide, and since no pass rate is published, our CHN pass rate analysis explains what can and cannot be said responsibly about outcomes.
The Four Content Domains
The official exam outline divides content into four domains totaling 100%. The distribution is heavily lopsided, and that lopsidedness should drive how you spend your preparation time.
Domain 2: Dialysis and Related Issues (74.5%)
This is the heart of the exam. Roughly three of every four questions come from the clinical practice of delivering and managing hemodialysis. Expect to be tested on the full arc of a treatment and the patient surrounding it.
- Hemodialysis principles: diffusion, ultrafiltration, convection, and how prescriptions are built
- Vascular access: fistulas, grafts, and catheters, including assessment, cannulation, and complication recognition
- Intradialytic complications such as hypotension, cramping, and disequilibrium, and the nursing response
- Anticoagulation management and monitoring
- Adequacy of dialysis and the lab values nurses use to evaluate it
- Pharmacology relevant to renal patients, including medications commonly given in the dialysis setting
- Patient assessment, anemia and mineral-bone disorder management, nutrition, and fluid status
Domain 1: Supervision/Management (10%)
This domain covers the leadership and coordination side of dialysis nursing, including delegation, staffing judgment, and oversight of care delivered by others. Note a naming quirk: the official outline PDF labels it Supervision/Management, while BONENT's website overview refers to it as Supervision/Administration. They describe the same domain.
Domain 4: Environmental Control (10%)
Dialysis is a technology- and water-dependent therapy, so this domain tests the safety systems around the patient. Think infection prevention, water treatment and quality, equipment and machine safety, and a clean, controlled treatment environment.
Domain 3: Professional Development (5.5%)
The smallest slice addresses professional growth, education, and practice standards. It is low-weighted but usually among the most approachable points on the exam.
For a domain-by-domain breakdown with sample focus areas, see our complete guide to the four CHN content areas.
Key Takeaway
With 74.5% of the outline in Dialysis and Related Issues, a candidate who is excellent in the other three domains but shaky in clinical dialysis content will struggle. Treat Domain 2 as the exam and the other three as support.
Who Qualifies to Sit
Eligibility is built around licensure plus real-world nephrology experience. The standard route has two tiers depending on your license type:
- Registered Nurse (RN): an eligible RN license and one year of nephrology experience.
- Licensed Practical/Vocational Nurse (LPN/LVN): an eligible LPN/LVN license and two years of nephrology experience.
In both cases, your experience must involve active work with ESRD patients, and you need two signed references. There is also an approved corresponding nurse-training pathway as an alternative; it requires confirmation from BONENT plus supporting documentation, so contact BONENT before assuming you qualify through that route. Authorization and application deadlines apply, which means you cannot simply decide on a Friday and test on Saturday. For the full eligibility walkthrough, read our CHN requirements guide.
Fees and Registration Mechanics
BONENT publishes a simple fee structure with no separate member and non-member tiers. The figures below reflect the current fee webpage, which supersedes the older fee table in the linked general handbook (revised January 2021).
| Candidate Type | Paper Exam | CBT Exam |
|---|---|---|
| U.S. | USD 235 | USD 255 |
| International | USD 260 | USD 255 |
An optional USD 100 expedite fee is available if your timeline is tight. Once certified, maintenance costs USD 65 annually or USD 240 prepaid for the full four-year cycle. Prepaying works out cheaper than paying year by year (USD 260 over four years versus USD 240 prepaid). Our CHN certification cost breakdown adds the surrounding costs of study materials and time off.
On timing, authorization and application deadlines apply, so check current windows in our CHN exam dates guide before building a study calendar around a particular test date.
Testing Rules and Accommodations
Under the linked BONENT handbook, the exam is closed book. Personal calculators and personal reference devices are not permitted. That has a direct implication for preparation: any dialysis math you need, such as ultrafiltration rates or fluid removal targets, must be something you can work out by hand or recognize conceptually without outside tools.
Two further clarifications are worth making so you do not plan around a false assumption:
- Computer-based testing is delivered through a network of testing sites. It is not a verified at-home option, so plan for travel to an approved location.
- Accommodations are available for candidates who need them. Request these early, since they typically require documentation and processing time.
Where CHN Holders Work
The certification is relevant wherever hemodialysis is delivered. Typical employers and settings include:
- Outpatient dialysis facilities: the largest employment setting, including facilities run by national dialysis organizations and independent providers
- Hospital dialysis units: acute inpatient dialysis, including bedside treatments for critically ill patients
- Home dialysis programs: training and supporting patients who perform treatments at home
- Nephrology practices and transplant programs: roles that touch dialysis patients along their care continuum
- Long-term care and rehabilitation settings that partner with dialysis providers
Certification is often valued as evidence of verified competence in a specialized, high-acuity field, and it can support advancement into charge, educator, or management roles. We discuss the employment landscape in CHN jobs, the earnings picture in our CHN salary guide, and whether the investment makes sense in the CHN certification ROI analysis. We avoid quoting specific pay figures here because compensation varies widely by region, employer, and experience.
Keeping the Credential Active
The certification is valid for four years. Renewal is not automatic, and you have two main paths:
- Contact-hour route: complete 40 contact hours, of which at least 30 must be in nephrology topics.
- Examination or waiver route: retake and pass a qualifying examination, or use the once-in-lifetime waiver where eligible.
Because the standard route rewards steady learning, many certified nurses simply log relevant continuing education as they go instead of scrambling at the end of the cycle. Note that the 2026 renewal booklet is a renewal document and is not an update to the exam version itself, so do not read it as signaling a change in what the exam covers.
Sequencing Your Preparation
This is the one place we will talk about study structure, and only in terms of how the CHN outline should shape your calendar. Because the current detailed exam outline is undated and no universal prep-hour total has been verified, there is no official number of hours to hit. Instead, allocate time in proportion to the domain weights, front-loading the heavy clinical content.
Domain 2 core: treatment and access
- Dialysis principles, prescriptions, and adequacy
- Vascular access assessment, cannulation, and complications
- Intradialytic complications and nursing responses
Domain 2 support: patient management
- Anticoagulation, renal pharmacology, anemia, and mineral-bone disorder
- Nutrition, fluid status, and laboratory interpretation
Domains 4 and 1
- Water treatment, infection control, and equipment safety
- Delegation, supervision, and oversight principles
Domain 3 and full-length practice
- Professional development and practice standards
- Timed 150-question practice sets to build 3-hour stamina
For a fuller plan, see our CHN study guide, the one-page CHN cheat sheet for last-minute review, and our candid take on how hard the CHN exam is. When you are ready to test yourself under realistic conditions, our CHN practice tests mirror the multiple-choice format so you can build both knowledge and pacing.
Frequently Asked Questions
It stands for Certified Hemodialysis Nurse, a nursing certification administered by BONENT. It is distinct from other credentials that share the acronym. For related phrasing, see our pages on what CHN certification is and CHN certification more broadly.
The exam has 150 multiple-choice questions with a 3-hour time limit. BONENT does not disclose how many are scored versus unscored, so treat every question as if it counts.
No. The passing standard is a scaled score of 70 on a 1-100 scale, not a verified 70% raw score. Because the raw-to-scaled conversion is not published, aim for strong performance across all domains rather than targeting a minimum number of correct answers.
Dialysis and Related Issues, which makes up 74.5% of the outline. The remaining domains are Supervision/Management (10%), Environmental Control (10%), and Professional Development (5.5%). Weight your time accordingly while still covering all four.
An at-home route has not been verified. Computer-based testing runs through a linked network of testing sites, and paper exams are offered under approved onsite proctoring, so plan to test at an approved location.