The few reuse and large stockpile of iron ore tailings (IOT) led to a series of social and environmental problems. This study investigated the possibility of using the IOT as one of starting materials to prepare lightweight ceramisite (LWC) by a high temperature sintering process. Coal fly ash (CFA) and municipal sewage sludge (SS) were introduced as additives. The LWC was used to serve as a biomedium in a biological aerated filter (BAF) reactor for municipal wastewater treatment, and its purification performance was examined. The effects of sintering parameters on physical properties of the LWC, and leaching concentrations of heavy metals from the LWC were also determined. The microstructure and the phase composition of the LWC were analyzed by scanning electron microscopy (SEM) and X-ray diffraction (XRD). Results revealed that: (1) IOT could be used to produce the LWC under the optimal sintering parameters: (2) the leaching concentrations of heavy metals from the LWC were well below their respective regulatory levels in the China Environmental Quality Standards for Surface Water (CEQS); and (3) the BAF reactor with the LWC serving as the biomedium achieved high removal efficiencies for CODCr (>92%), NH4+-N (>62%) and total phosphate (T-P) (>63%). Therefore, the LWC produced from the IOT was suitable to serve as the biomedium in the municipal wastewater treatment. (C) 2010 Elsevier B.V. All rights reserved.