Objective To systematically evaluate the impact of continuous renal replacement therapy (CRRT) on the pharmacokinetics of polymyxin B, explore its possible impacting factors. Methods PubMed, Embase, Cochrane Library, Web of Science, VIP database, China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang data were retrieved. The study subjects were patients receiving CRRT and polymyxin B. Observational studies, case reports, and reviews were included. The outcome indicators included therapeutic drug monitoring results, pharmacokinetic parameters, and CRRT parameters. The retrieval time was from the inception of each database to January 2025. The quality of literatures was evaluated with ClinPK tool. Two researchers independently conducted literature screening, data extraction, and quality evaluation. Results A total of 12 literatures were ultimately included in analysis, including 1 review, 3 case reports, and 8 observational studies. Five studies showed that the clearance rate during CRRT period (1.3-6.66 L/h) was higher than that during non-CRRT period (0.5-3.9 L/h). Five studies reported that the area under the steady-state 24-hour drug concentration-time curve (AUC_{ss, 24h}) during CRRT period (21.58-75.1 mg·h/L) was lower than that during non-CRRT period (60.6-118 mg·h/L). Two studies detected drugs in ultrafiltrate or dialysate, with in vitro drug recovery rates ranging from 5.62% to 24.0%. Two studies reported a decrease in drug concentration after passing through a blood filter. Conclusion During CRRT period, polymyxin B presents higher clearance rate and lower blood drug concentration, and some patients have lower AUC_{ss, 24h} than the therapeutic target. The mechanism of this change during CRRT is not yet clear, the therapy mode and filter type may be potential impacting factors, further research are needed to promote precise anti-infective treatment.