Background: chronic kidney disease (CKD) risk factors have been increased in the Saudi population. Therefore, primary health care physicians play a major role in controlling these risk factors, and prevent further kidney damage. Sometimes, Nephrology consultation is needed to provide them with an ideal medical care as soon as the diagnosis is made. Purpose: The aim of the study was to assess the level of satisfaction among nephrologists towards primary health care referral system.  Methods: a cross-sectional study was carried out in Riyadh city, Saudi Arabia. Participants were nephrologists who work in major hospitals. A designed questionnaire was used for data collection consisted of demographic data of the participant, causes of referral, quality of referral forms, and patients' care prior referral.  Results: a total of 89 nephrologists were recruited in the study, most of them were males and non-Saudi physicians. Confirming the diagnosis and providing recommended treatment for the patients are the most common causes for referral. Most of the participants were satisfied about quality of referral and prior referral care. There was no difference in the satisfaction level among consultants compared to specialists. Whereas, private sector nephrologists were more satisfied. Conclusion: Governmental hospitals have to work harder to improve their health system, as they are the main source for most of Saudi citizens' health problems. Providing a nephrologist with good referral letter, and good communication between primary care physicians and other medical specialties provides a better health care to the patients.