How do you counsel patients with CKD who are on a PPI given a prior observational study showing an association between PPI use and incident CKD?  

I am a little conflicted about this topic and have changed my practice in the last 4-5 years.There are multiple observational studies that suggest an association between PPI and CKD but residual confounding remains a concern in these studies. A nice commentary on this topic was published last year i...

The lowering of magnesium is almost universal. That would be a factor in my decision as well as the pattern of progression of CKD as it relates to the timing of the PPI. I often recommend a trial of discontinuation and try to maintain the patient of a PPI if GI symptoms do not worsen.