Nowadays the application of Anammox based processes in the wastewater treatment plants has given a step forward. The new goal consists of removing the nitrogen present in the main stream of the WWTPs to improve their energetic efficiencies. This new approach aims to remove not only the nitrogen but also to provide a better use of the energy contained in the organic matter. The organic matter will be removed either by an anaerobic psychrophilic membrane reactor or an aerobic stage operated at low solids retention time followed by an anaerobic digestion of the generated sludge. Then ammonia coming from these units will be removed in an Anammox based process in a single unit system. The second strategy provides the best results in terms of operational costs and would allow reductions of about 28%.Recent research works performed on Anammox based processes and operated at relatively low temperatures and/or low ammonia concentrations were carried out in single-stage systems using biofilms, granules or a mixture of flocculent nitrifying and granular Anammox biomasses. These systems allowed the appropriated retention of Anammox and ammonia oxidizing bacteria but also the proliferation of nitrite oxidizing bacteria which seems to be the main drawback to achieve the required effluent quality for disposal. Therefore, prior to the implementation of the Anammox based processes at full scale to the water line, a reliable strategy to avoid nitrite oxidation should be defined in order to maintain the process stability and to obtain the desired effluent quality. If not, the application of a post-denitrification step should be necessary.