{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:11:47Z","timestamp":1769519507135,"version":"3.49.0"},"reference-count":0,"publisher":"Pakistan Medical Association","issue":"11","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Pak Med Assoc"],"abstract":"<jats:p>The widespread use of proton pump inhibitors (PPIs) hasraised safety concerns, especially among patients withchronic kidney disease (CKD), where long-term use hasbeen linked with acute interstitial nephritis (AIN),hypomagnesaemia, and potential progression to endstagekidney disease (ESKD). Recent observational studiesand meta-analyses have yielded mixed evidence, calling fora nuanced and individualized approach to acid suppressionin CKD. The concept of gut guardianship emphasizescautious, indication-based prescribing, dose minimization,and structured deprescribing to preserve gut\u2013renal health.This article reviews the current evidence and proposes aclinical toolkit for rational PPI use in CKD, based on riskstratification, guideline-based indications, and ongoingmonitoring.Keywords: Acid suppression, Chronic kidney disease, Gutmicrobiome, Nephrotoxicity, Proton pump inhibitors<\/jats:p>","DOI":"10.47391\/jpma.25-94","type":"journal-article","created":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T17:20:03Z","timestamp":1761499203000},"page":"1822-1824","source":"Crossref","is-referenced-by-count":1,"title":["Gut Guardianship: Recommendations for Rational Use of Proton Pump Inhibitors in Chronic Kidney Disease"],"prefix":"10.47391","volume":"75","author":[{"family":"Sourabh Sharma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Pawan Rawal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Sanjay Kalra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"26547","published-online":{"date-parts":[[2025,10,21]]},"container-title":["Journal of the Pakistan Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/jpma.org.pk\/index.php\/public_html\/article\/download\/33460\/4480","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jpma.org.pk\/index.php\/public_html\/article\/download\/33460\/4480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T17:20:04Z","timestamp":1761499204000},"score":1,"resource":{"primary":{"URL":"https:\/\/jpma.org.pk\/index.php\/public_html\/article\/view\/33460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":0,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,10,26]]}},"URL":"https:\/\/doi.org\/10.47391\/jpma.25-94","relation":{},"ISSN":["0030-9982","0030-9982"],"issn-type":[{"value":"0030-9982","type":"electronic"},{"value":"0030-9982","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10,21]]}}}