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Primary keys ensure data integrity by uniquely identifying each record in a database, preventing duplicates and enabling efficient data retrieval. They also facilitate relationships between tables, enhancing database normalization. However, disadvantages include the potential for performance issues if the primary key is large or complex, and the challenges of managing changes—such as when a primary key needs to be updated, which can complicate related data. Additionally, poor primary key selection can lead to design flaws, impacting overall database efficiency.

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