- Patient Care is 45% of the CHT exam - study it more than every other domain combined.
- You need a scaled score of 70 on a 1-100 scale, not 70% raw accuracy.
- The exam is 150 questions in three hours, closed-book, no calculators allowed.
- U.S. computer-based testing costs $255; certification lasts four years with $65 annual maintenance.
CHT At A Glance
The Certified Hemodialysis Technologist/Technician (CHT) credential is administered by the Board of Nephrology Examiners Nursing & Technology (BONENT). This one-page cheat sheet condenses the numbers, domain weights, and eligibility rules you need in the final stretch before test day. It is not a substitute for full preparation - pair it with the CHT Study Guide 2026 for a complete first-attempt strategy - but it works well as a last-week reference or a quick refresher printed out and taped next to your desk.
The Five Domains, Ranked By Weight
BONENT structures the CHT exam around five content domains. Knowing the weight of each domain tells you exactly where your study hours should go. For a deeper walkthrough of every topic inside each domain, see the CHT Exam Domains 2026 guide.
Domain 1: Patient Care - 45%
The largest domain by a wide margin, covering nearly half the exam. Expect heavy coverage of dialysis initiation and termination, vascular access assessment, vital signs monitoring, complications during treatment, and patient assessment before, during, and after dialysis.
- Vascular access types (fistula, graft, catheter) and complication recognition
- Intradialytic complications: hypotension, cramping, disequilibrium
- Pre-, intra-, and post-treatment patient assessment
Domain 4: Infection Control - 18%
The second-largest domain. This section tests standard precautions, bloodborne pathogen protocols, and dialysis-specific infection prevention in a shared treatment environment.
- Standard precautions and personal protective equipment use
- Disinfection and reprocessing procedures
- Outbreak prevention specific to ESRD facilities
Domain 3: Water Treatment - 15%
Covers the water purification systems that make safe dialysis possible, including monitoring and troubleshooting.
- Water treatment system components and function
- Water quality testing and monitoring schedules
- Troubleshooting common water system failures
Domain 2: Machine Technology - 12%
Focuses on the dialysis machine itself - setup, operation, alarms, and maintenance.
- Machine setup and priming procedures
- Alarm recognition and troubleshooting
- Routine maintenance and equipment safety checks
Domain 5: Education and Professional Development - 10%
The smallest domain, covering patient education responsibilities and the technician's professional scope.
- Patient and family education principles
- Professional and ethical responsibilities
- Scope of practice for hemodialysis technicians
| Domain | Weight | Study Priority |
|---|---|---|
| Patient Care | 45% | Highest |
| Infection Control | 18% | High |
| Water Treatment | 15% | Medium |
| Machine Technology | 12% | Medium |
| Education & Professional Development | 10% | Lower |
Exam Format, Scoring, and Fees
The CHT exam contains 150 multiple-choice questions administered in a three-hour window. It is closed-book and in-person proctored - personal calculators and outside reference materials are not permitted. Testing runs on the SMT/ISO-Quality Testing network for computer-based delivery, and a paper-and-pencil option is also available. A Spanish-language version of the exam exists for candidates who prefer it.
Key Takeaway
Passing requires a scaled score of at least 70 on a 1-100 scale - this is not the same as answering 70% of raw questions correctly. See the CHT Passing Score 2026 breakdown for how scaled scoring actually works.
Fees differ by location and format:
- U.S. candidates: $255 computer-based, $235 paper-and-pencil
- International candidates: $255 computer-based, $260 paper-and-pencil
- Optional expedited processing: $100 add-on
Once your computer-based testing eligibility is confirmed, you must complete the exam within six months. Missing that window means restarting the application process. For a full cost breakdown including recertification fees, check the CHT Certification Cost 2026 guide, and confirm your testing window against current dates on the CHT Exam Dates 2026 page.
Eligibility Snapshot
Standard eligibility for the CHT exam requires three things: a high-school diploma or official transcript, six months of nephrology patient-care experience, and active participation in an ESRD facility. There are two notable exceptions worth remembering:
- Graduates of BONENT-approved training programs can apply within two years of completing their program without needing the six-month patient-care experience requirement.
- Candidates with more than four years of dialysis experience may use that experience to waive the diploma documentation requirement.
You'll also need two signed and dated professional references - one from your immediate supervisor and one from a nephrology professional. If you're currently unemployed but otherwise qualify, a previous supervisor's reference is acceptable. Full detail on every pathway, including edge cases, lives in the CHT Requirements 2026 guide.
Recertification Cheat Sheet
CHT certification lasts four years. Annual maintenance costs $65 per year, or you can prepay $240 to cover all four years upfront. As long as maintenance stays current, there's no additional routine recertification fee.
For the 2026 renewal cycle, the continuing-education route requires 40 contact hours total, with at least 30 of those hours classified as nephrology-focused Group A content. If continuing education isn't practical, you can instead re-take the exam, or use the once-in-a-lifetime continuing-education waiver if you qualify. One more detail worth remembering: after a third unsuccessful exam attempt, BONENT requires eight nephrology continuing-education hours before you can sit again.
| Item | Detail |
|---|---|
| Certification length | 4 years |
| Annual maintenance | $65/year or $240 prepaid for 4 years |
| CE hours required (2026) | 40 total, 30+ Group A nephrology-focused |
| Alternative to CE | Re-examination or one-time CE waiver |
| After 3rd failed attempt | 8 nephrology CE hours required |
A Focused Final-Week Review Plan
Generic study techniques only matter when they're mapped to the actual domain weights. In your final week before the CHT exam, allocate review time proportionally rather than evenly across all five domains.
Patient Care Deep Review
- Run through vascular access complications and intradialytic emergencies
- Drill pre/intra/post-treatment assessment sequences until automatic
Infection Control
- Review standard precautions and reprocessing protocols
- Take the optional 50-question official practice exam ($60) to gauge readiness
Water Treatment
- Trace the full water treatment system and monitoring checkpoints
- Review common troubleshooting scenarios
Machine Technology
- Review alarm codes and machine setup steps
- Practice recall of routine maintenance checks
Education Domain + Full Mix Review
- Cover patient education and scope-of-practice basics
- Do a mixed review session touching all five domains, weighted toward Patient Care
This mirrors the exam's own emphasis: more time on Patient Care and Infection Control, proportionally less on Education and Professional Development. For a broader assessment of how much total prep time the exam typically demands, see How Hard Is the CHT Exam? Complete Difficulty Guide 2026.
Must-Know Clinical Topics by Domain
Beyond the domain weights themselves, certain topics show up repeatedly in candidate feedback and BONENT's own study guide as high-yield areas worth memorizing cold:
- Dialyzer and dialysate composition: know standard electrolyte ranges and how dialysate adjustments affect patient outcomes.
- Anticoagulation during treatment: heparin protocols and recognizing signs of inadequate or excessive anticoagulation.
- Access cannulation technique: step-by-step cannulation for fistulas and grafts, plus catheter care basics.
- Water system components: reverse osmosis, deionization, and carbon tank function within the treatment chain.
- Machine alarm hierarchy: which alarms require immediate technician response versus routine adjustment.
- Documentation and scope boundaries: what a technician can chart, communicate, or act on independently versus escalate.
These topics cut across multiple domains, which is exactly why BONENT's blueprint rewards broad clinical fluency rather than narrow memorization. If you want to understand why the exam is structured this way and what it means for pass outcomes, the CHT Pass Rate 2026 analysis is a useful companion read.
Key Takeaway
Use the official 50-question, $60 practice exam as a diagnostic tool in the final week - not as your primary study method. It tells you which domain needs another pass before test day.
Once certified, most CHTs work in outpatient dialysis centers, hospital-based renal units, and home dialysis training programs. If you're weighing whether the credential fits your career path, the Is the CHT Certification Worth It? ROI Analysis 2026 article and the CHT Salary Guide 2026 both go deeper into job outlook and earnings context. You can also browse current openings that request the credential on the CHT Jobs page.
Before exam day, run a handful of timed question sets through our practice test platform to simulate the three-hour, 150-question format under realistic conditions. Repeating that process a few times on the full practice test site is one of the simplest ways to confirm your pacing before you sit for the real thing.
FAQs
The CHT exam has 150 multiple-choice questions and a three-hour time limit, delivered either by computer-based testing or paper-and-pencil.
You need a scaled score of at least 70 on a 1-100 scale. This scaled score is not the same as raw percentage accuracy on the 150 questions.
Patient Care, at 45% of the exam, is by far the largest domain and should receive proportionally more study time than any other section.
Certification lasts four years. Annual maintenance is $65 per year or $240 prepaid for all four years, with the 2026 renewal cycle requiring 40 continuing-education hours, at least 30 of them nephrology-focused Group A hours.
No. The CHT exam is closed-book and in-person proctored, and personal calculators and outside reference materials are not permitted.