Hydrothermal carbonization of sewage sludge was carried out with the aim to evaluate the influence of process severity and initial solid content. Response surface methodology was applied to model yield and C yield responses. Enhanced dewaterability performance was recorded under mild processing conditions. The treatment promoted concentration and immobilization of Pb, Cd, Ni, Zn, and Cu. Variation of the solid content showed a stronger influence than severity on average yield and C yield. Higher heating values (HHVs) and energy retention efficiencies (EREs) of hydrochars obtained at the lowest solid content displayed the lowest values. Hence, the energy requirements of a first dewatering step should be compared with the related improvement in terms ofHHVandEREwhen sludge is used as feedstock.