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Chronic kidney disease is a common medical problem. It is characterized by a peculiar course leading to renal osteodystrophy resulting in increased risk of fractures and joint lesions with the concomitant need for major joints arthroplasty. Moreover, a wide spectrum of organ and metabolic deteriorations due to renal insufficiency causes a more complicated postoperative period with higher mortality and frequent infectious, cardiovascular, hemorrhagic, thrombotic and surgical complications. The highest risks are noted in patients on long lasting hemodialysis.To improve the arthroplasty outcomes an adequate correction of anemia, bone-mineral and electrolyte disorders, arterial hypertension and optimization of dialytic modalities must be ensured.