Rapidly growing discharge of nitrogen-rich saline wastewater has significantly affect environment. However, due to the inhibition resulting from high salinity on microbes, it is still a challenge to treat nitrogen-rich saline wastewater efficiently. Anammox process, as a cost-effective and environment-friendly nitrogen removal approach, has shown a potential in treating nitrogen-rich saline wastewater. This review is conducted from a critical perspective and provides a comprehensive overview on the performance of anammox process treating nitrogen-rich saline wastewater. Two strategies including freshwater-derived anammox bacteria acclimatization and marine anammox bacteria enrichment are evaluated. Second, effects resulting from salinity on the performance of anammox reactor, the microbial communities and sludge characteristics are discussed. Third, salinity-tolerant mechanism of anammox bacteria is analyzed. This review also reveals some critical knowledge gaps and future research needs, which benefits application of anammox process to treat nitrogen-rich saline wastewater.