The smart management of water resources is an increasingly important topic in today’s society. In this context, the paradigm of Smart Water Grids (SWGs) aims at a constant monitoring through a network of smart nodes deployed over the water distribution infrastructure. This facilitates a continuous assessment of water quality and the state of health of the pipeline infrastructure, enabling early detection of leaks and water contamination. Acoustic-wave-based technology has arisen as a viable communication technique among the nodes of the network. Such technology can be suitable for replacing traditional wireless networks in SWGs, as the acoustic channel is intrinsically embedded in the water supply network. However, the fluid-filled pipe is one of the most challenging media for data communication. Existing works proposing in-pipe acoustic communication systems are promising, but a comparison between the different implementations and their performance has not yet been reported. This paper reviews existing works dealing with acoustic-based communication networks in real large-scale urban water supply networks. For this purpose, an overview of the characteristics, trends and design challenges of existing works is provided in the present work as a guideline for future research.