This study focuses on the anaerobic treatment of sulfate-containing municipal wastewater at 20 °C with a fluidized bed reactor. Mean influent chemical oxygen demand (COD) and sulfate concentrations were 481 and 96 mg/l. The response of the COD removal efficiency to increasing organic loading rates (OLR) was investigated. Average total COD removal was 61% at OLR between 2.7 and 13.7 kg COD/(m³·d) and did not distinctly depend on the OLR. To assess the removal efficiency in more detail the COD in- and output mass flows were balanced. The results showed that only 11–12% of the input COD was recovered as gaseous methane. About 12–13% of the input COD remained in the effluent as dissolved methane. Furthermore, a distinct amount of 12–19% of the input COD remained in the reactor as settled sludge and was not further biologically degraded. Due to the reduction by sulfate-reducing bacteria, 13–14% of the input COD was degraded. Further adverse impacts of the influent sulfate on the anaerobic treatment process are discussed as well.