This study assessed the technical feasibility of treating sewage with a combination of direct anaerobic treatment and autotrophic nitrogen removal, while simultaneously achieving energy recovery and nitrogen removal under moderately low temperatures. The concentrations of ammonia, nitrite, and COD in effluent were below 1, 0.1, and 30 mg/L, respectively. In the up-flow, anaerobic sludge fixed-bed, there was no obvious change observed in the total methane production at temperatures of 35 +/- 1 A degrees C, 28 A +/- 1 A degrees C, 24 A +/- 3 A degrees C, and 17 A +/- 3 A degrees C, with the accumulation of volatile fatty acids occurring with decreasing temperatures. The control strategy employed in this study achieved a stable effluent with equimolar concentrations of nitrite and ammonium, coupled with high nitrite accumulation (> 97 %) in the partial nitrification sequencing batch reactor system at moderately low temperatures. In the anaerobic ammonium oxidation (anammox) reactor, a short hydraulic retention time of 0.96 h, with a nitrogen removal rate of 0.83 kgN/(m(3)/day) was achieved at 12-15 A degrees C. At low temperatures, the corresponding fluorescence in situ hybridization image revealed a high amount of anammox bacteria. This study demonstrates that efficient nitrogen removal and energy recovery from sewage at moderately low temperatures can be achieved by utilizing a combined system. Additionally, this system has the potential to become energy-neutral or even energy-producing.