How do I not violate this primary key when syncing with Azure?
I don't think the error is where you think it is. If the PK on the local and Azure ListItems both name the same columns (irrespective of order), they are the same. The error message, however, mentions a different PK definition (and a different tablename):
Violation of PRIMARY KEY constraint 'PK__#A4D1762__44A4C03D49E5E4B8'. Cannot insert duplicate key in object 'dbo.@changeTable'. The duplicate key value is (1, 1).
There appears to be a table whose name is "@changetable" -- which looks like a store procedure parameter to me -- that is defined with a two-column primary key. Track it down and you'll solve the problem.