Denosumab Use in Chronic Kidney Disease Associated Osteoporosis: A Narrative Review

Abduelmula R Abduelkarem,1,2 Adnane Guella,3 Amar M Hamrouni,4 Mohammed M Hassanein,1 Ahmed Nasr,5 Owais Rana6 1Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates; 2Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 3Department of Nephrology, University Hospital Sharjah, Sharjah, United Arab Emirates; 4Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates; 5Pharmacy Department, University Hospital Sharjah, Sharjah, United Arab Emirates; 6Department of Internal Medicine, University Hospital Sharjah, Sharjah, United Arab EmiratesCorrespondence: Abduelmula R Abduelkarem, Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates, Tel +97165057443, Email [email protected]: Chronic kidney disease (CKD) and hemodialysis (HD) patients have a high incidence of bone disease and increased fracture risk, making effective management of their bone health a clinical challenge. Denosumab, a human monoclonal antibody, has been investigated as a therapeutic option in this patient population. In this review, we summarize the current evidence on the efficacy and safety of denosumab in CKD and HD patients. A comprehensive search of the relevant literature was conducted, including randomized controlled trials, observational studies, and meta-analyses. The findings suggest that denosumab reduces the risk of fractures and improves bone mineral density in all stages of CKD. The results of this review support the use of denosumab as a promising option for managing bone disease in CKD and HD patients.Keywords: denosumab, chronic kidney disease, hemodialysis, bone disease, fracture risk reductio

Affinity replica selection in distributed systems

Replication is one of the key techniques used in distributed systems to improve high data availability, data access performance and data reliability. To optimize the maximum benefits from file replication, a systems that includes replicas need a strategy for selecting and accessing suitable replicas. A replica selection strategy determines the available replicas and chooses the most access files. In most of these access frequency based solutions or popularity of files are assuming that files are independent of each other. In contrast, distributed systems such as peer-to-peer file sharing, and mobile database, files may be dependent or correlated to one another. Thus, this paper focused on the combination of popularity and affinity files as the most important parameters in selecting replicas in distributed environments. Herein, a replica selection is proposed focusing on popular files and affinity files. The idea is to improve data availability in distributed data replica selection strategy. A P2P simulator, PeerSim, is used to evaluate the performance of the dynamic replica selection strategy. The simulation results provided a proof that the proposed affinity replica selection has contributed towards a new dimension of replica selection strategy that incorporates the affinity and popularity of file replicas in distributed systems