As for rendering, the SDF can be rasterized in shader, or it can be cube-marched to mesh and rendered in standard pipeline. It would be great to hear your opinions on both methods in context of real-time graphics.
Edit: Here's a video of Dreams shape manipulation https://youtu.be/D4Kk36oqGMY?t=589
The basic idea is that if you evaluate the SDF at a given point, you get the distance to the nearest surface. Thus, you know it is safe to step that far in any direction without crossing a surface. So you can step along a ray with a step size determined by the SDF at each point to quickly converge on a surface.
How would you end up with badly-formed SDFs?
So in practice what you try to do is find an SDF that is not TOO far off from what it should be. Ideally, it should always have an absolute value that is equal to or less than (but not by too much) the real, ideal SDF.