Anaerobic ammonium oxidation (Anammox) process is a type of biological nitrogen removal technology which is known to directly convert ammonium and nitrite to nitrogen gas. The freshwater ‘Candidatus Kuenenia stuttgartiensis’ anammox under the phylum of Planctomycetes is used to study the parameters that affect the anammox development and the metabolic pathways alongside the associated enzymes. These observations were made using state-of-the art techniques for detecting anammox bacteria based on their small-subunit ribosomal RNA genes, functional genes and unique reaction pathways. This review systematically summarizes up-to-date studies on the parameters affecting the growth of the anammox bacteria and metabolic networks driving anammox bacterial anabolism and mixotrophy beyond genome-based predictions. The K. stuttgartiensis survives in summer and winter conditions besides in the aerobic zones (dissolved oxygen >2 mg/L), which consequently contribute to better nitrogen removal in the wastewater treatment. Furthermore, the K. stuttgartiensis utilizes the Wood–Ljungdahl pathway to directly assimilate extracellular formation instead of oxidising it completely to CO2 prior reassimilation.