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Because of the low energy costs in the absence of the need for aeration, the non-requirement of a carbon source and alkali, and the reduced production of excess sludge, anaerobic ammonia oxidation (Anammox) has been extensively studied as an alternative to the conventional nitrification–denitrification pathway for biological nitrogen removal from wastewater. However, many challenges remain which need to be overcome to prepare the process for engineering application. These include the long doubling time of Anammox bacteria/autotrophic ammonia-oxidizing bacteria (AAOB), the low tolerance capacity to substrate concentration, and high sensitivity to various environmental factors. This review article focuses on the main drawbacks of the Anammox process and evaluates the progress made to date with regard to the enrichment of AAOB and the treatment performance of the Anammox process itself …