Prior to a new federal requirement for national certification of hemodialysis technicians in 2008, I was state certified like most dialysis technicians in California and was content with my knowledge, skills, and abilities (KSA). I had been working in dialysis facilities and training programs for years and mentored others but had little knowledge, interest, or encouragement in pursuing national certification. My compensation was slightly higher than most technicians but by no means comfortable. National certification seemed to provide a qualification for advancing in my career but I had concern with the cost of the application and return on investment. Was it worth it?

A personal review of the exams

The requirement to certify gave me the itch to take every examination available. I now am fully certified by the National Nephrology Certification Commission (NNCC), National Nephrology Certification Organization (NNCO), and the Board of Nephrology Examiners Nursing and Technology (BONENT).

My years of practical experience were not enough to pass these exams; it took research of evidence-based practices. I found myself preparing with documents I had never thought to use before: Medicare’s Conditions for Coverage, Centers for Disease Control and Prevention guidelines for infection control, and the Core Curriculum for Dialysis Technicians (see the Resources page in this section) which I recommend as the best reference for clinical certification preparation.

Following is a profile of the different exams you can take that I believe offer some real value in improving your professional skills. These are my personal reviews; every technician may find a different experience.

  • Certified Biomedical Nephrology Technician (CBNT)

The CBNT examination is not a mandatory certification for biomedical technicians but does have an elite group of professionals carrying the title. When thinking of taking the examination, I queried friends who had passed the test on what to study. Each time they responded with “experience should be enough.” I found that there was very little guidance in biomedical nephrology to help with this exam, but did find, “Dialysis technology: A manual for dialysis technicians” by Curtis and Varghese (2003; available on helpful. In the end, experience was my greatest aid in passing this exam.

  • Certified Clinical Nephrology Technician (CCNT)

The clinical examination from NNCO was a standard test with typical knowledge requirements. Application is a bit pricier than the other certifications. What I like about the NNCO certifications is the continuing education requirement of 10 hours per year. That should keep the education relevant to the time of certification.

  • Certified Clinical Hemodialysis Technician-Advanced (CCHT-A)

The CCHT was the most “taker-friendly” examination with simple questions and obvious answers. I earned the honor of highest scorer on the CCHT examination and when the CCHT-A examination became available I was one of the first to take the test. I did not see much difference in the CCHT and CCHT-A examinations and expected more of a challenge in the advanced certification.

  • Certified Hemodialysis Technician (CHT)

I have always heard that the BONENT examinations are difficult so I prepared for both with studies of literature and good rest because I was nervous. After taking all of the examinations, I concurred that BONENT was the most challenging. Earning the CHT title also brought a deep trust in the industry from colleagues and employers that definitely boosted self-confidence, making it my most proud certification.

Evaluating the benefits

Certification examinations promote a level of professional competency hitherto existent in the renal community. With fair time to comply after the final rule was issued for national certification, it is my opinion that we have improved quality in the last five years in hemodialysis settings by weeding out unqualified technicians, refining the KSAs of those that remain, and setting a higher standard of training and competency for certification in the future. It has enhanced my KSAs and opened doors I never knew existed for a dialysis technician.

Fellow technicians began asking if I could help them prepare for certification examinations, giving me the nickname “the dialysis tutor.” Many were surprised by questions on subjects not applicable in their facility of employment and, in some cases, facility policy and procedure clouded knowledge of relevant industry guidelines, regulations, and recommendations. There was definitely a trend in the training of failing technicians coming from specific dialysis organizations.

I was inspired to work with BONENT to open an accredited dialysis training school. I hired a team of interdisciplinary educators, including registered nurses, dietitians, social workers, biomedical technicians, and clinical technicians that collectively have raised the bar in dialysis technician training. In 2010 we earned a continuing education provider (CEP) number from the California Board of Registered Nurses to add nurses to the list of clientele.

Participation in professional organizations helped to create a new opportunity consulting with health care-associated companies. My first opportunity was with electronic medical record companies, training staff on the process of dialysis to incorporate better efficient workflows into their software. Other jobs include work with dialysis providers, training programs, and training systems for new hire medical assistants and medical office support. My certification along with a little professional networking even brought hospital executive from China for a few consultations on how to incorporate technicians into their renal team.

Requests to help in the development of industry tools are an opportunity I never had before certification. Contribution and review of the 5th edition of the Core Curriculum was an honor and challenge that I hope to have again. Most recently I have partnered with a professional group to produce the first study guide for biomedical nephrology technicians.


Certification was a blessing on personal, professional, and financial levels. My role has changed from direct delivery of care to an enhanced ability to reach patients with quality care delivered by my students. I am much more involved in the dialysis community, and teaching, consulting, writing, and public speaking is a part of my job description. Suddenly I am earning several times what I did prior to certification and employing a team of specialists that would normally be my boss. Financially the return on investment is significant enough that I would challenge all technicians to gain every certification available. It will pay dividends for you and your career.