In recent years, the anammox process has emerged as a useful method for robust and efficient nitrogen removal in wastewater treatment plants (WWTPs). This paper evaluates a one-stage deammonification (nitritation and anammox) start-up using carrier material without using anammox inoculum. A continuous laboratory-scale process was followed by full-scale operation with reject water from the digesters at Bekkelaget WWTP in Oslo, Norway. A third laboratory reactor was run in operational mode to verify the suitability of reject water from thermophilic digestion for the deammonification process. The two start-ups presented were run with indigenous bacterial populations, intermittent aeration and dilution, to favour growth of the anammox bacterial branches. Evaluation was done by chemical and fluorescence in situ hybridization analyses. The results demonstrate that anammox culture can be set up in a one-stage process only using indigenous anammox bacteria and that a full-scale start-up process can be completed in less than 120 days.