Partial nitrification (nitritation) – anammox (anaerobic ammonia oxidation) process is increasingly used to treat wastewater, characterized by a high nitrogen content and high temperature (25 - 40°C). It is connected with the optimal temperature of anammox bacteria, which is at the range between 30 and 40°C. Mainstream application of anammox for the municipal wastewater, characterized by lower temperature seems to be one of the most challenging, but profitable process. Thenceforth, the research performed in the field of the nitritation – anammox at low temperature (10 - 20°C) become more and more intense. Compared with the conventional nitrification – denitrification system, nitritation – anammox reduces oxygen demand, eliminates the need for organic carbon source and produces less excess sludge. As a result, it allows to a significant cost reduction. This paper reviews the most important and recent information in the field of nitritation – anammox process at low temperature. Effective nitrogen removal from the municipal wastewater was demonstrated at 15°C in a pilot scale and at 12°C in a laboratory scale reactor. The best performance is achieved in sequencing batch reactors and moving bed reactors with biofilm or granular biomass, as well as combinations of these technologies. Molecular biology studies shows that anammox bacteria of the genus Candidatus Brocadia may have the biggest predispositions to adapt to low temperature. However, temperature about 10°C, time and method of biomass adaptation are still the main challenges for stable and common nitritation – anammox process.