The simultaneous partial nitritation, anammox, denitrification, and COD oxidation (SNADCO) method was successfully carried out in an air-lift moving bed biofilm reactor (AL-MBBR) with cylinders carriers for the treatment of digested fish processing wastewater (FPW). Synthetic wastewater was used as substrate at stage 1. It changed into the digested FPW with dilution variation in order to increase the nitrogen and COD loading rates. With influent concentration of NH4+-N of 909 ± 101 mg-N/L and COD of 731 ± 26 mg/L, the nitrogen removal efficiency was 86.8% (nitrogen loading rate of 1.21 g-TN/L/d) and the COD removal efficiency was 50.5% (COD loading rate at 0.98 g-COD/L/d). This study showed that the process has the advantages in treating the real high ammonia concentration of digested wastewater containing organic compounds. The nitritation and anammox route was predominant in nitrogen removal, while COD oxidation and microbe proliferation played the main role in COD removal.