Partial nitritation and anaerobic ammonium oxidation (PNA) is a useful process for the treatment of nitrogen-rich centrate from the dewatering of anaerobically digested sludge. A one-stage PNA moving bed biofilm reactor (MBBR) was started up without inoculum at Klagshamn wastewater treatment plant, southern Sweden. The reactor was designed to treat up to 200 kgN d-1, and heated dilution water was used during start-up. The nitrogen removal was >80% after 111 days of operation, and the nitrogen removal rate reached 1.8 gN m-2 d1 at 35 °C. The start-up period of the reactor was comparable to that of inoculated full-scale systems. The operating conditions of the system were found to be important, and online control of the free ammonia concentration played a crucial role. Ex situ batch activity tests were performed to evaluate process performance.