On the basis of the radiological findings of dialysis patients, we made a radiological grading and analyzed the progression of destructive spondyloarthropathy (DSA) using this grading system. In this system, the radiological features of the vertebral endplates and intervertebral disc spaces were divided into 4 grades (grade 0 to grade III). Grades II and III were defined as DSA. In this study, out of the 787 dialysis patients (447 men and 340 women, mean age: 60.0 years) examined, 133 patients (16.9%) were diagnosed with DSA. During 7 years follow-up, 108 dialysis patients were examined to investigate the clinical characteristics of DSA. Fifteen of 90 non-DSA cases progressed to DSA. Six of 18 DSA cases showed grade progression. The duration required for progression of each grade was analyzed. A new classification of DSA, namely, degenerative DSA and classical DSA, was applied in this study. The degenerative DSA showed faster grade progression than the classical DSA. Therefore, great attention should be paid in the radiological follow-up of elderly patients with grade I who start dialysis at an old age.